AMA Group of Companies

AFFIDAVIT OF LOSS OF ID CARD

Rev: 30 March 2002

REPUBLIC OF THE PHILIPPINES }

QUEZON CITY, METRO MANILA } S.S.

AFFIDAVIT OF LOSS

I, (Emp# ________________) __________________________, of legal age,

Filipino, with residence and postal address at __________________________________
____________, after having been duly sworn to in accordance with law hereby depose
and state that:

1. I am presently employed with <company> <branch> _______________

as ________________________ (position);
2. By virtue of my employment, I was issued an Identification Card;
3. Said Identification Card was lost sometime on ____________________
at ____________________________;
4. Hereunder are the facts and circumstances surrounding the loss of my
Identification Card:
_________________________________________________________
_________________________________________________________
_________________________________________________________
5. I made diligent search to recover the said Identification Card but proved
futile;
6. For all legal intents and purposes the said Identification Card is now
considered lost and beyond recovery;
7. 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 _____________ day of

___________________20__, 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. ___________;
HF-HRD-AOL
 AMA Group of Companies
AFFIDAVIT OF LOSS OF ID CARD
Rev: 30 March 2002

Series of 20___

HF-HRD-AOL