Republic of the Philippines )

QUEZON CITY ) S.S.

AFFIDAVIT

I, XXX, of legal age, widower, Filipino, with postal address at

XXX, after having been duly sworn to in accordance with law,
hereby deposes and states that:

1. I am a holder of a COMELEC ID issued in my name by

the Commission on Elections;

2. On or about December of 2014, I visited my friend in

Fairview;

3. When I am on my way home, I boarded a bus from

Fairview to Cubao, Quezon City;

4. After boarding the said bus, I found out that my wallet is

missing together with my COMELEC ID;

5. I have exerted diligent effort to locate/recover the said

identification card but the same could not be found and
is now beyond recovery;

6. I am executing this affidavit to attest to the truthfulness

of the foregoing statements and for whatever legal
purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this _______________ at Quezon City.

XXX
Affiant