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Affidavit of Loss Gambong

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REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU
) S.S.
x--------------------------------/.

AFFIDAVIT OF LOSS

I, DAISY ANN S. GAMBONG, of legal age, Filipino, single and a resident of Blk 2,
Lot 27, Deca Homes, Phase 2, Talisay City, after having been duly sworn to in accordance with
law, depose and state THAT :
1. Last March 03, 2016, I was somewhere at Labangon when I noticed that my wallet was
not in my bag;
2. My wallet contains my Access Card of EXL Service Phil bearing no. 94028, my key
for pedestal #500, and my SSS I.D bearing no 0925102960;
4. Efforts were exerted to locate the same, but in spite of diligent search, it could not be
found creating a belief that I probably inadvertently lost it somewhere which is now beyond
recovery ;
5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and
for the purpose of issuance of a new access card, key for pedestal #500 and SSS I.D.
IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of March, in Cebu
City, Philippines.
DAISY ANN S. GAMBONG
Affiant
SUBCRIBED AND SWORN TO before me this 10th day of March 2016 in Cebu
City, Philippines, affiant exhibiting to me her competent evidence of identity by way of
a_______________________issued at __________________issued on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of ______.

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