Affidavit of Loss1

Republic of the Philippines)
City of Zamboanga ) S.S.

X - - - - - - - - - - - - - - - - - - - -x
AFFIDAVIT OF LOSS
(CITATION TICKET)
I, EHZRAN HAIDAR M. YAHIYA, of legal age, single, Filipino, with postal

address at Talon-talon, Zamboanga City, under oath depose and say:
That I was issued a citation ticket, however, the same was lost in my
possession on October 12, 2021;
That efforts were exerted to locate the said Citationticket but the same
proved futile and in vain, hence, I considered it lost and beyond recovery;
That I am executing this affidavit to attest to the truth of the foregoing

narration of fact and for whatever legal purpose this may serve in general.
IN WITNESS WHEREOF, I hereunto set my hand this 21 st day of October

2021, at Zamboanga City, Philippines.
EHZRAN HAIDAR M. YAHIYA

Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this 21ST day of October 2021,

in Zamboanga City, Philippines.
ATTY. TIMHAR M. ASDAON

PUBLIC ATTORNEY II
PURSUANT TO RA 9406
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AFFIDAVIT OF LOSS
I. ARTHUS A. ALMODIEL of legal age, single, Filipino, with postal address

at Tictapul, Zamboanga City, under oath depose and say:
That I know the person of EFREN APOLINARIO PEDRO because he is my

father;
That during his confinement at the Zamboanga City Medical Center,

Zamboanga City, I bought medicine in his name;
That I was issued the following official receipt with numbers :
O.R. # 2768077 - Php 2,105.00

O.R.# 2768041 - Php 150.00 and
O.R.# 2685884 - Php 183.75 all dated April 11, 2013;
That said receipts was issued by the Zamboanga City Medical Center,
Zamboanga City;
That sometime April 2013 after his death the said receipt were misplaced or
lost;
That effort were exerted to locate the said RECEIPTS but the same proved
futile and in vain, hence, I considered it lost beyond recovery;

IN WITNESS WHEREOF, I hereunto set my hand this 12 th day of August,

RAMIL G. PEDRO
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this 12 th day of August, 2013,

ATTY. IRIS MAY MENDOZA - MACROHON

PUBLIC ATTORNEY II
PURSUANT TO RA 9406
Doc. No. _____;

Page No. _____;
Book No. II ;
Series of 2016.

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AFFIDAVIT OF LOSS
I, ROMMEL S. LUNA, of legal age, married, Filipino, with postal address at

Boalan, Zamboanga City, under oath depose and say:
That I am a graduate of Brent Hospital and Colleges Inc., with a degree of

Bachelor of Science in Nursing;
That I was given a school diploma upon graduation, however, the same
was lost sometime in the year 2015;
That efforts were exerted to locate the said DIPLOMA but the same proved
futile and in vain, hence, I considered it lost and beyond recovery;

IN WITNESS WHEREOF, I hereunto set my hand this 20 th day of June 2018,

at Zamboanga City, Philippines.
CLEENA V. BARRIOS
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this 19 th day of June 2018, in

Zamboanga City, Philippines.
ATTY. KARINA ANGELA E. FERNANDEZ

PUBLIC ATTORNEY III
PURSUANT TO RA 9406
Doc. No. ______;

Page No. ______;
Book No. II ;
Series of 2017
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AFFIDAVIT OF LOSS
I. ROY M. BORJA of legal age, single, Filipino, with postal address at Don
Toribio ST., Tetuan, Zamboanga City, under oath depose and say:
That I was issued a Non Government Fee Receipt by the Zamboanga State
College of Marine Sciences and Technology, Zamboanga City;
That the said Receipt was lost in my possession last April 4, 2017;
That efforts were exerted to locate the said Receipt but the same proved
futile and in vain, hence, I considered it lost beyond recovery;


ROY M. BORJA
Affiant

ATTY. LYNETTE A. LACANDALO

PUBLIC ATTORNEY II
PURSUANT TO RA 9406
Doc. No. _____;

Page No. _____;
Book No. II ;
Series of 2017.
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AFFIDAVIT OF LOSS
I, KAREN SUSIE L. WEE, of legal age, single, Filipino, with postal address
at Km. 7, Upper Pasonanca, Zamboanga City, under oath depose and say:
That I am working with the Shopper’s Group of Companies, Zamboanga

City as a Junior Supervisor;
That last October 26, 2011, Jimmy Palanas one of the supplier of foot wear
delivered the said item at the Shopper Center the Gateway, Zamboanga City and I
was issued a sales invoices with nos. 003282, 003283, 003284 and 003286 and
sales invoice no. 003285 dated December 4, 2011 by Jimmy Palanas with office
address at No. 92 Crista Street, Madaluyong City, Metro Manila;
That the said above sales Invoices were all processed for payment but for
whatever reason it was not collected by Jimmy Palanas on time. It was only
sometime last February 12, 2013 when Jimmy Palanas came and collect the
payment of the above mentioned sales invoices;
That said sales invoices where misplaced in the office;
That effort were exerted to locate the said sales invoices but the same
proved futile and in vain, hence, I considered it lost beyond recovery;

IN WITNESS WHEREOF, I hereunto set my hand this 27 th day of February,

2013 at Zamboanga City, Philippines.
KAREN SUSIE L. WEE

Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this 27 th day of February, 2013,

ATTY. IRIS MAY MENDOZA - MACROHON

PUBLIC ATTORNEY II
PURSUANT TO RA 9406
Doc. No. _____;

Page No. _____;
Book No. II ;
Series of 2016.
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AFFIDAVIT OF LOSS
(Transcript of Record)
I, ROSALIE M. BANLAYGAS, of legal age, single, Filipino, with postal

address at Katilingban, Sinunuc, Zamboanga City, under oath depose and say:
That I am a graduate of Western Mindanao State University, Zamboanga

City with a degree of Bachelor of Science in Social Work;
That I was given a Transcript of Record upon graduation, however, the

same was lost sometime in the year 2016;
That efforts were exerted to locate the said TRANSCRIPT OF RECORD but
the same proved futile and in vain, hence, I considered it lost and beyond
recovery;


ROSALIE M. BANLAYGAS
Affiant


PUBLIC ATTORNEY III
PURSUANT TO RA 9406
Doc. No. ______;

Page No. ______;
Book No. II ;
Series of 2017
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AFFIDAVIT OF LOSS
(Transcript of Record)
I, WILMA R. GARCIA, of legal age, single, Filipino, with postal address at

123 Cabato Rd., Tetuan, Zamboanga City, under oath depose and say:
That I am a member of the Philippine Health Insurance Corporation;
That I was given a PhilHealth ID, however, the same was lost in my
possession on January 15, 2018;
That efforts were exerted to locate the said PhilHealth ID but the same
proved futile and in vain, hence, I considered it lost and beyond recovery;

IN WITNESS WHEREOF, I hereunto set my hand this 18 th day of January

WILMA R. GARCIA
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this 18 th day of January 2018,


PUBLIC ATTORNEY III
PURSUANT TO RA 9406
Doc. No. ______;

Page No. ______;
Book No. II ;
Series of 2018

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Republic of the Philippines)

City of Zamboanga ) S.S.

I, EHZRAN HAIDAR M. YAHIYA, of legal age, single, Filipino, with postal

That I am executing this affidavit to attest to the truth of the foregoing

IN WITNESS WHEREOF, I hereunto set my hand this 21 st day of October

EHZRAN HAIDAR M. YAHIYA

SUBSCRIBED AND SWORN TO BEFORE ME this 21ST day of October 2021,

ATTY. TIMHAR M. ASDAON

I. ARTHUS A. ALMODIEL of legal age, single, Filipino, with postal address

That I know the person of EFREN APOLINARIO PEDRO because he is my

That during his confinement at the Zamboanga City Medical Center,

That I was issued the following official receipt with numbers :

O.R. # 2768077 - Php 2,105.00

That I am executing this affidavit to attest to the truth of the foregoing

IN WITNESS WHEREOF, I hereunto set my hand this 12 th day of August,

SUBSCRIBED AND SWORN TO BEFORE ME this 12 th day of August, 2013,

ATTY. IRIS MAY MENDOZA - MACROHON

Doc. No. _____;

Republic of the Philippines)

I, ROMMEL S. LUNA, of legal age, married, Filipino, with postal address at

That I am a graduate of Brent Hospital and Colleges Inc., with a degree of

That I am executing this affidavit to attest to the truth of the foregoing

IN WITNESS WHEREOF, I hereunto set my hand this 20 th day of June 2018,

SUBSCRIBED AND SWORN TO BEFORE ME this 19 th day of June 2018, in

ATTY. KARINA ANGELA E. FERNANDEZ

Doc. No. ______;

That I am executing this affidavit to attest to the truth of the foregoing

IN WITNESS WHEREOF, I hereunto set my hand this 19 th day of June 2017,

SUBSCRIBED AND SWORN TO BEFORE ME this 19 th day of June 2017, in

ATTY. LYNETTE A. LACANDALO

Doc. No. _____;

That I am working with the Shopper’s Group of Companies, Zamboanga

That said sales invoices where misplaced in the office;

That I am executing this affidavit to attest to the truth of the foregoing

IN WITNESS WHEREOF, I hereunto set my hand this 27 th day of February,

KAREN SUSIE L. WEE

SUBSCRIBED AND SWORN TO BEFORE ME this 27 th day of February, 2013,

ATTY. IRIS MAY MENDOZA - MACROHON

Doc. No. _____;

I, ROSALIE M. BANLAYGAS, of legal age, single, Filipino, with postal

That I am a graduate of Western Mindanao State University, Zamboanga

That I was given a Transcript of Record upon graduation, however, the

That I am executing this affidavit to attest to the truth of the foregoing

IN WITNESS WHEREOF, I hereunto set my hand this 20 th day of June 2017,

SUBSCRIBED AND SWORN TO BEFORE ME this 20 th day of June 2017, in

ATTY. KARINA ANGELA E. FERNANDEZ

Doc. No. ______;

I, WILMA R. GARCIA, of legal age, single, Filipino, with postal address at

That I am a member of the Philippine Health Insurance Corporation;

That I am executing this affidavit to attest to the truth of the foregoing

IN WITNESS WHEREOF, I hereunto set my hand this 18 th day of January

SUBSCRIBED AND SWORN TO BEFORE ME this 18 th day of January 2018,

ATTY. KARINA ANGELA E. FERNANDEZ

Doc. No. ______;

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