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REPUBLIC OF THE PHILIPPINES )

CITY OF QUEZON) S.S.


x----------------------------x

AFFIDAVIT OF LOSS

I, Joanna Baun, Filipino, of legal age, Single and a resident of Block 11, Lot
13, Mt. Heights Subdivision, Barangay 183, Caloocan City, Philippines, after
being duly sworn to in accordance with law, hereby depose and state:

1. That I am an employee of CONVERGYS SERVICES CORPORATION at


UP Science and Technology (North), Commonwealth Avenue, Diliman,
Quezon City, Philippines;

2. That on the 19th of July 2016, at around 12:00 to 1:00 oclock pm, I lost
my Convergys Access Card, which I usually place in my right-hand
pocket.

3. That despite my diligent search and effort to locate the Access Card, I
believe that it is now lost beyond recovery for all legal purposes.

4. As such, I am executing this Affidavit of Loss to attest to the truth of the


foregoing for any purpose my employer has for said document.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of July
of 2016, in Quezon City, Philippines.

1
____________________
Joanah Carrera Baun
Affiant
TIN ID No. 311-169-244-000

SUBCRIBED AND SWORN TO BEFORE ME,


this ___________________ in Quezon City, Philippines, affiant exhibiting
to me his/her competent evidence of identity by way of her Tax Identification
Number, numbered 311-169-244-000 issued on ______________ .

NOTARY PUBLIC

Doc. No. _____;


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