Republic of the Philippines}

City of Manila

} S.S.

AFFIDAVIT OF LOSS

I, Marniel S. Balasabas, of legal age, married, Filipino and a resident of Block 9, Lot
10, Phase D, Woodlane Town Homes, Imus, Cavite, having been duly sworn in
accordance with law, hereby depose and state that:
1. That I am a holder of a claim stub issued by GFI International Manpower;
2. That the said claim stub was lost;
3. That despite my effort to locate the said claim stub proves futile;
4. That I am executing this affidavit to attest to the truth of the foregoing facts and to
request GFI International Manpower to release the passport in virtue of the lost
claim stub.

IN WITNESS WHEREOF, I have hereunto set my hand this 11 th day of March 2015,
at City of Manila, Philippines.

_____________________
Affiant

SUBSCRIBED AND SWORN to me before this 11th day of March at City of Manila,
the affiant having exhibited to me his SSS ID with No. 34-0106734-8 issued at Quezon
City.

NOTARY PUBLIC

Doc. No.________;
Page No.________;
Book No.________;
Series of 2015.