REPUBLIC OF THE PHILIPPINES)

CITY OF __________________) S.S.

AFFIDAVIT OF LOSS
I, KRISTINE JOYCE M. MENDOZA, of legal age, Filipino and with office address at No. 153,
EDSA, Barangay Wack-Wack, Mandaluyong City, after being sworn in accordance with law,
depose and state that:
1. I am the Marketing Officer of Eagle Cement Corporation (the “Company”), a
corporation duly organized and existing under and by virtue of the laws of the Republic
of the Philippines;
2. As such Marketing Officer, the invoices of suppliers and/or vendors are sent to my
office for processing and safekeeping;
3. That sometime in _____________, one of the invoices from _____________ with
Number ___________ cannot be located;
4. That despite of diligence search and efforts, the same could no longer be found such
that I believe the it is now lost beyond recovery;
5. Thus, I am executing this Affidavit of Loss to attest to the truth of the foregoing and
for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __________ day of

___________ 2018 at _____________, Philippines.

KRISTINE JOYCE M. MENDOZA

Affiant

SUBSCRIBED AND SWORN to before me, this ____________ day of ___________ by

the affiant having exhibited to me her competent evidence of identity denominated as
________________________..

Doc. No. ___;

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