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Loss - UMID

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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SAMAR…………...) S.S.


CITY OF CATBALOGAN………….)

AFFIDAVIT OF LOSS

I, MARLITA D. BAGUIO, of legal age, married, Filipino, and with


residence at 221 B, San Francisco St., Catbalogan City, Samar, after
having been duly sworn to in accordance with law, do hereby depose
and state: that-

1. I am a government employee at BIR Calbayog RDO 087,


Calbayog City; as such, I am a bonafide member of the
Government Service Insurance System (GSIS) with UMID card
issued in my favor;

2. Unfortunately, however, sometime in September 2023,


the said GSIS UMID card was lost when I discovered it was no
longer in my possession or I might have dropped while I was
in Manila; and notwithstanding repeated searched my efforts
to recover it, the same proved futile, such that I now consider
said GSIS UMID card lost for all intents and purposes

3. The loss of said UMID card is made in good faith and


never intended to defraud the GSIS, other entities and
instrumentalities and third persons nor in pursuance
something illegal;

4. I am executing this statement to attest the truth of all


the foregoing and to request for a new GSIS UMID card in lieu
of the one lost and for other legal purposes.

IN WITNESS WHEREOF, I have hereunto affix my signature this 7 th


day of November 2023 at Catbalogan City,

MARLITA D. BAGUIO
Affiant

SUBSCRIBED AND SWORN to before me this 7 th day of November


2023 at Catbalogan City, affiant exhibiting to me her National ID No.
4310-5628-5172-5894.
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF SAMAR…………...) S.S.
CITY OF CATBALOGAN………….)

AFFIDAVIT OF LOSS

I, LAURA B. BOLLER, of legal age, married, Filipino, and with


residence at Brgy. Payao, Catbalogan City, Samar, after having been
duly sworn to in accordance with law, do hereby depose and state:
that-

5. I am a teacher by profession with present assignment at


Samar State University, Main Campus, Catbalogan City,
Samar; as such, I am a bonafide member of the
Government Service Insurance System (GSIS) with UMID
card issued in my favor which I long kept in our filing
cabinet at home and commingled with other pertinent
papers and documents

6. However, on 16 May 2023, as I was collating my papers


and documents at home, I discovered that UMID card was
missing in my filing cabinet and notwithstanding efforts to
locate it, the same proved futile such that I now declare it
lost for all intents and purposes;

7. Notwithstanding earnest search and lapse of reasonable


period of time, the said UMID card could no longer be
found that I now consider it lost for all intents and
purposes;

4. The loss of said UMID card is made in good faith and never
intended to defraud the GSIS, other entities and
instrumentalities and third persons nor in pursuance
something illegal;

8. I am executing this affidavit to attest the truth of all the


foregoing and to support my application to renew my
professional license with the PRC and for other legal
purposes.

IN WITNESS WHEREOF, I have hereunto affix my signature this 10 th


day of February 2015 at Catbalogan City.

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