REPUBLIC OF THE PHILIPPINES )

CITY OF ______________________ )) S.S.

AFFIDAVIT OF LOSS

That I, APOLONIO L. BALBUENA, legal age, married, Filipino and with office
address at Suite 107-C Criselda 2 Bldg. 107 Scout De Guia Street, Brgy. Sacred heart, Diliman,
Quezon City After having duly sworn to in accordance with law do hereby depose and say:

1. That I am the President of EMCJ Manpower International Inc., a corporation duly

organized and existing under and by virtue of the laws of the Republic of the Philippines;

2. That sometime on September 22, 2014, the original copy of the Medical Certificate of Ms.
Ruby Advento from Arguelles Medical Clinic could not be found and that despite diligent search
and efforts, the same could no longer be found, such that I believe it is now lost beyond
recovery;

3. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and for
whatever legal purposes that this may serve.

IN WITNESS WHREOF, I have hereunto set my hand and affix may signature this 04th
day of August, 2014 at Quezon City, Metro Manila.

APOLONIO L. BALBUENA
Affiant

SUBSCRIBED AND SWORN TO before me this ______ day of __________________,

20___ at ______________________, affiant exhibiting to me his _________________________
issued at _________________ and valid until ______________.

Doc. No. _______

Page No. _______
Book No. _______
Series of ________