Republic of the Philippines)

Quezon City ) S.S.

AFFIDAVIT OF LOSS

I, CECIL B. BAUZA, Filipino, of legal age, widow, and with residential address
at Xavier Hills Condominium, N. Domingo corner Granada Streets, Valencia, Quezon
City, after having been duly sworn, hereby state:

1. That I am an employee of the Philippine Amusement and Gaming Corporation

(PAGCOR);

2. That I am the widow of the late Enrico Novilla Bauza, who was likewise an
employee of PAGCOR (ID No. 89-0180) and served as a Pit Officer thereof until his
death on 14 October 2019;

3. That as the widow of the late Enrico N. Bauza, I am facilitating the claims for his
lawful employment and other related benefits which requires, among others, the
presentation of his PAGCOR Employee’s ID, PAGCOR Healthcare ID, and Gaming
Employment License;

4. That despite diligent search and effort to locate the said IDs, I could not find them
and I now believe that they are lost beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
facts and to support my claims for the benefits to which my late husband is legally
entitled.

IN WITNESS WHEREOF, I have hereunto set my hand this 09 July 2020 in

Quezon City, Philippines.

CECIL B. BAUZA
Affiant
PAGCOR I.D. No. 89-0347

SUBSCRIBED AND SWORN to before me this __________________

here in ________________. Affiant exhibited to me her PAGCOR ID bearing the
number above-indicated as proof of her identity.
Doc. No ____;
Page No. ____;
Book No. ____;
Series of 2020.