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____________________________) S.S.

I, JUAN C. DELA CRUZ, of legal age, single, Filipino, and with residence and
postal address _____________________ after having been duly sworn to in accordance
with law, hereby depose and state:

1. That I am the holder of the following:

a.) Unified Multi-Purpose Id (UMID), issued to me by Social Security

System, (SSS);

b.) Company Identification card issued to me by HC Finance

Consumer Philippines, with office address at Dasmariñas City,

c.) High School Diploma, issued to me by Noveleta National High

School, Batch 2006.

2. That sometime on July 2017, the said identification cards and High
School Diploma that I kept in the cabinet was among those
belongings that I lost when our place was heavily flooded due to

3. That the torrential rains caused the unexpectedly sudden and

devastating flow of very high flood water that inundated thousands of
residential houses including my place;

4. That during that time, we were not able to save all our belongings;

5. That after the heavy rains and flood, as I was making an inventory,
the said documents were missing;

6. That I exerted diligent and thorough efforts to look for the missing
identification cards and High School Diploma, but the same proved

7. That in view of this incident, it is now impossible to recover the said

identification cards and High School Diploma ;

8. That I executed this Affidavit of Loss to attest to the truth of the

foregoing facts and circumstances for whatever legal purposes this
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________

at _____________.



SUBSCRIBED AND SWORN to before me this ______________ at

_______________ Affiant exhibited to me his TIN _________________, issued by
Bureau of Internal Revenue (BIR).

Doc No. ________;

Page No. _______;
Book No. _______;
Series of 2018.