Republic of the Philippines)

Pasay City, Metro Manila ) S.S.

AFFIDAVIT OF LOSS

I, FATIMA C. ANCHETA, of legal age, married, Filipino citizen, with residence address at
267 Gahak, Kawit, Cavite, under oath, depose and state:

(1) That I was a former employee of SM Development Corporation, located at Two-

Ecom, Mall of Asia Complex, Palm Coasts Drive, Pasay City;

(2) That I was issued a SM Development Corporation Identification Card or ID on

_________;

(3) That on or around __________ while leaving our office and going home, I lost the
said SM Development Corporation ID;

(3) That diligent search of said document among my personal effects proved futile and
unavailing;

(4) I am executing this affidavit to comply with the requirements of SM Development

Corporation for the reconstitution of said document.

Affiant further sayeth naught.

FATIMA ANCHETA

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of January 2018 in Pasay City,
Metro Manila, affiant exhibiting to her Community Tax Certificate No. __________
issued on _____________ at ____________.

Doc. No. ____;

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