REPUBLIC OF THE PHILIPPINES)

Province of Cavite ) S.S.

City of General Trias )
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AFFIDAVIT OF LOSS

I, JOSE MARI TITO MAYLON, Filipino, of legal age, single, with residence and
postal address at Block 6 Lot 61, Lavanya Square Subdivision, Barangay Bacao II, City
of General Trias, cavite , City of General Trias, Cavite, after having been duly sworn to in
accordance with law, hereby depose and state:

1. That at present, I am employed as a Production Operator in House Technology

Industries Pte Ltd. (HTI) located at CEZ 2, Barangay Bacao II, City of General
Trias, Cavite, Philippines and for which reason, I have been issued by the said
company a company identification card, zone pass and parking identification
card;

2. That regrettably on December 8, 2019 at around 6:00 in the morning, while I was
on my way to my workplace located at CEZ 2, Barangay Bacao II, City of General
Trias, Cavite, I discovered that the said company identification card, zone pass
and parking identification card have been missing and were no longer inside my
pants’ pocket where I previously kept them. That possibly such company
identification card, zone pass and parking identification card unknowingly or
accidentally fell to the ground while I was on my way to my workplace earlier that
day;

3. That diligent efforts to find such company identification card, zone pass and
parking identification card from the time of the discovery of their loss and up to
the present were exerted, but such efforts proved to be futile since I haven’t
recovered yet such company identification card, zone pass and parking
identification card up to this time;

4. Thus, such company identification card, zone pass and parking identification card
duly issued by the House Technology Industries Pte Ltd. (HTI), should now be
considered lost and are likewise beyond recovery and this circumstance thus
authorizes the undersigned to secure corresponding replacement for such cards
from HTI;

5. That this affidavit is voluntarily and knowingly executed to attest to the truth of the
foregoing declaration and for any other legal purpose it may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 9th day of December,
2019 at the City of General Trias, Cavite, Philippines.

JOSE MARI TITO MAYLON

Affiant

SUBSCRIBED AND SWORN to before me this 9th day of December, 2019,

at the City of General Trias , Cavite with the affiant exhibiting a competent proof of his
identity, the number and the date of issuance which are written below his name.

Doc. No.: 406 ;

Page No.: 83 ;
Book No.: L ;
Series of 2019