REPUBLIC OF THE PHILIPPINES)

CITY OF LUCENA ) SS.

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

AFFIDAVIT OF LOSS

I, ROMEL D. DEL MUNDO, of legal age, Filipino, single, and a resident of Lot 54
Block 6, Phase 4-A St. John St., St. Jude Village, Lucena CIty, Philippines, after having
been duly sworn in accordance with law, hereby depose and state:

1. That I work as Bill Review Services Associate III in the Conduent Business
Services Philipiines Inc.;

2. That I was issued a LENOVO M70e Personal Computer with a Mouse with Serial
No. MOUSEStrata Care0049 to be used in my work in the said company;

3. That I have replaced the said Mouse during my work in our former home at Purok
San Francisco Brgy. Ibabang Dupay, Lucena City, since it malfunctioned and I
have plced it in a box where I usually put my personal belongings;

4. That when we moved to our new house in St. Jude Village last 2020, I cannot
locate the aforementioned box where I have kept the Mouse;

5. That immediately upon discovery of the same I have exerted diligent efforts to
locate said Mouse in probable places but the same could no longer be found and
considered irretrievably lost;

6. That I am executing this Affidavit loss to support the report I have made to my
immediate supervisor;

7. That I executed this affidavit in order to attest to the truth of the foregoing and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of January

2023 at Lucena City, Philippines.

ROMEL D. DEL MUNDO

Affiant
UMID No. 0111-0412404-3

SUBSCRIBED AND SWORN to before me, this 30th day of January 2023 at
Lucena City, Philippines.

Doc. No. 141; ATTY. CHRISTOPHER P. JUNIAR

Page No. 29 Notary Public
Book No. 01
Attorney’s Roll No. 77224
Series of 2023.
PTR No. 3416706 01/03/2023 Lucena City
IBP O.R. No. 256546 12/31/2022 Pasig City
Tax Identification No. 277-604-758
MCLE exempted, pursuant to
MCLE Governing Board Order No. 1, s, 2008