Republic of the Philippines ) S.S.

Province of Bulacan )

AFFIDAVIT OF LOSS

I, MELVIN P. CANDELARIA, of legal age, Filipino, single and a resident of 275

Unit 7 Balubad St., Bulakan, Bulacan, after having been duly sworn to in accordance
with law, hereby depose and state, THAT:

1. I am a former employee of Mercantile Store Group Inc., SM Baliuag Branch

from July 2017 to November 2017;

2. I was issued a Certificate of Employment for the services rendered in the said
company;

3. However, sometime in September 2020, when I was on my way home, I

realized that I left the folder containing my Certificate of Employment and
other equally important documents in the van I was riding;

4. That despite diligent search to locate the said Certificate of Employment, I can
no longer find it and I now consider it irretrievably lost;

5. That I am executing this affidavit to attest the truth of the foregoing facts to
support my application for the issuance of new Certificate of Employment in
lieu of the lost one and for whatever legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day October, 2021
herein Guiguinto, Bulacan.

MELVIN P. CANDELARIA
Affiant

SUBSCRIBED AND SWORN TO me, a Notary Public for and in Guiguinto,

Bulacan this October 4, 2021, and affiant exhibited to me his Phil. Passport No.
PO206109A as his competent evidence of identity.

Doc No. ____;

Page No. ____;
Book No. ____;
Series of 2021.