Republic of the Philippines)

City of Zamboanga )S.S.

x-------------------------------x

AFFIDAVIT OF LOSS
I, DESIREE JOY MONGCABONG BULAY-OG, of legal age, Filipino citizen
and a resident of Mormons Drive, Tetuan, Zamboanga City, Philippines, after
having been duly sworn to in accordance with law, hereby depose and say that:

1. I am the lawful holder of a Company Identification Card, duly issued by

the ZAMPEN HOSPITAL, Zamboanga City;

2. The said ID got lost when Severe Tropical Storm Paeng triggered strong
winds and floods throughout the night in different parts of Mindanao,
including our house at Mormons Drive, Tetuan, Zamboanga City,
Philippines;

3. I exerted all efforts to locate the said ID in all other places but the same
can no longer be found;

4. For all intents and purposes, I am now declaring the above-mentioned ID

lost and beyond recovery;

5. Furthermore, I am executing this Affidavit under oath and in good faith

to attest to the truth of the foregoing facts based of personal knowledge
and authentic records, and for whatever legal purposes it may serve.

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

at Zamboanga City, Philippines.

DESIREE JOY MONGCABONG BULAY-OG

Affiant
PRC ID No. 0032842

SUBSCRIBED AND SWORN to before me this ____________ at Zamboanga

City, Philippines. Affiant personally appeared and swore to the truth of the
foregoing.

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