REPUBLIC OF THE PHILIPPINES }

QUEZON CITY, METRO MANILA } S.S.

AFFIDAVIT OF LOSS
I, (Emp# 10003314) Samuel Ivan Ngan, of legal age, Filipino, with residence
and postal address at 19 Sorsogon St. Quezon City, after having been duly sworn to in
accordance with law hereby depose and state that:
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I am presently employed with Philippine Batteries Inc. as Analyst;

By virtue of my employment, I was issued an Identification Card;
Said Identification Card was lost sometime on August 2015
Hereunder are the facts and circumstances surrounding the loss of my
Identification Card:
I was going home on a Business trip, I used my company ID as
identification. I would usually just put it inside my bag and bring it out
when I need to. I could not find my ID since then. I probably misplaced it
or dropped it somewhere,
I made diligent search to recover the said Identification Card but proved
futile;
For all legal intents and purposes the said Identification Card is now
considered lost and beyond recovery;
I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose/s it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN TRUTH THEREOF, I have hereunto set my hand this sixteenth day of
November 2015, at __________________________, Philippines.
__________________
Affiant
SUBSCRIBED AND SWORN to before me this ___________________ day of
______________________ 20__ , affiant exhibited to me his/her Residence Cert. No.
__________________ issued at ___________________ on ______________________.
NOTARY PUBLIC
Doc. No. ___________;
Page No. ___________;
Book No. ___________;
Series of 20___

HF-HRD-AOL