REPUBLIC OF THE PHILIPPINES )

) S.S.
______________________________)
(State Location where Affidavit is Executed)

AFFIDAVIT OF LOSS

I, __________________________with Badge No. ______________ of legal age,

single/married a member of the Philippine National Police, presently assigned at
__________________________ of the Criminal Investigation and Detection Group and a
resident of _________________________________________________________________ ,
after having been duly sworn in accordance with law do hereby depose and say:

That I have an issued firearm described as (State Make/Kind/Caliber Serial No.of

Firearm), issued by (State Issuing PNP Unit).

That the Acknowledgement Receipt of Equipment (ARE)/Property Acknowledgement

Receipt (PAR) of my said firearm was lost sometime on (State Approximate Date/Time of
Loss) somewhere in (State Approximate Location). That I have exerted due effort to locate
the said document, however all my efforts proved futile.

That I am executing this affidavit in lieu of my ARE/PAR to support the processing of

my application for permanent issuance/renewal of permanent issuance of my PNP-issued
short firearm Re: PNP SOP No. 2002-05.

That to attest to the truthfulness of the above statements, I hereto affixed my signature
this _____ day of ____________________, 20___ here at ___________________________,
Philippines.

__________________________
Signature Over Printed Name
(Affiant)

SUBSCRIBED AND SWORN TO before me this ______ day of

___________________________, 20____, here at _________________________________,
Philippines, affiant exhibiting to me his PNP ID No. ______________________ issued on
____________________________ at Camp BGen Rafael T Crame, Quezon City.

___________________________
NOTARY PUBLIC

Doc No. __________

Page No. __________
Book No. _________
Series No. _________