Affidavit of Loss Stolen Wallet Cebuana Card

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Republic of the Philippines)

Province of  Cavite ) S.S.


Municipality of Alfonso ) 

AFFIDAVIT OF LOSS
I, MA. FLOREMAR JORNADAL, Filipino, of legal age and with residence
address at 34 Burgos St., Pob. I, Alfonso, Cavite, after being duly sworn to in
accordance with law, hereby depose and state, THAT:

1. I am in possession of Cebuana Lhuiller Card with Client no. 605710085646.

2. However, on February 10, 2020, while I was in Shaw Boulevard, one unknown
person stole my wallet together with the said Cebuana Lhuiller card;

3. Despite diligent search and efforts to recover the said Cebuana Lhuiller Card
the same can no longer be located and considered it lost beyond recovery;

4. I am executing this affidavit not for any unlawful purpose but only for the
purpose of application for replacement of the said Cebuana Lhuiller card.

IN WITNESS WHEREOF, I have hereunto set my hand this 12th day of March,
2020 at Province of Cavite, Philippines.

MA. FLOREMAR JORNADAL


Affiant

SUBSCRIBED AND SWORN to before me this 12th day of March, 2020 at


Alfonso, Cavite. Affiant exhibiting to me his Passport no. P1483925B exp. 16/04/2029.

WITNESS MY HAND AND SEAL.

Doc. No. 88 ;
Page No. 19 ;
Book No. LXXX;
Series of 2020.

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