Republic of the Philippines)

_________________________) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, Jocelyn Concio of legal age, Filipino, single, and a resident of 9517 Gahit Street. Barangay
Pinagbuhatan Pasig City, after having been sworn in accordance with law, hereby deposes and states the
following:

1. That I am a holder/owner of an identification card with number 2014F0013 issued by iFashion

Marketing Company;

2. I have recently discovered the said item/s is/are irretrievably lost and can no longer be found
despite diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

Affiant

(Signature over Printed Name)

Competent Evidence of Identity
ID:
issued on:
at:

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below. The affiant
exhibited to me his competent evidence of identity as indicated above.

Signed this ______________at ________________, ______________________, Philippines.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No.
Page No.
Book No. I
Series of