Republic of the Philippines )

Province of Isabela ) S.S.

City of Ilagan )

AFFIDAVIT OF LOSS

I, DAPHNE P. BALAUAG, of legal age, Filipino and a resident of Barangay

Upi, Municipality of Gamu, Isabela after having been sworn in accordance with
law, hereby depose and state:

1. That I am the same person executing this Affidavit;

2. That I am an issuant of a TAX IDENTIFICATION NUMBER CARD (TIN)

duly issued by the Bureau of Internal Revenue (BIR), LANDBANK ATM
CARD duly issued by the Land Bank of the Philippines, and GLOBE
OFFICIAL RECEIPT for Internet fees duly issued by Globe;

3. That I kept all my Identification Cards and Receipts inside my ID CASE;

4. That on July 28, 2018, when I was on my way home, I noticed that the
said ID CASE was missing from my wallet together with the above
mentioned TIN ID, LANDBANK ATM CARD, and GLOBE OFFICIAL
RECEIPT;

5. That the said TIN ID, LANDBANK ATM CARD, and GLOBE OFFICIAL
RECEIPT can no longer be found. Best efforts were exerted to locate
the said cards and receipt, but all efforts were in vain;

6. That the subject TIN ID, LANDBANK ATM CARD, and GLOBE OFFICIAL
RECEIPT is now considered lost and beyond recovery;

7. That I am executing this instrument to attest to the truthfulness and

veracity of the foregoing, to notify and request the Bureau of Internal
Revenue, Land Bank of the Philippines, and Globe regarding such loss
and for the issuance of a new TIN ID, LANDBANK ATM CARD, and
GLOBE OFFICIAL RECEIPT in lieu of the lost ones and for whatever
lawful purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 30 th day

of July, 2018 at City of Ilagan, Isabela.

DAPHNE P. BALAUAG
Affiant
PRC: 0428261

SUBSCRIBED AND SWORN to before me this 30th day of July, 2018 at City
of Ilagan, Isabela.