REPUBLIC OF THE PHILIPPINES )

XXXXXXXXXXXXXXXXXXX ) SS

AFFIDAVIT OF LOSS

I, XXXXXXXXXXXXXXXXXX, of legal age, Filipino, single and a

resident of XXXXXXXXXXXXXXXXXXX, after being duly sworn in
accordance with law, do hereby depose and say that:

1. I am a holder of a Company ID of XXXXXXXXXXXXXXX;

2. Said company ID was in my possession from the time of

issuance but unfortunately, last January 30, 2023, I discovered that
my company ID was missing when I was on my way home. I realized
that I was no longer wearing my company ID when I got off at
Bankerohan to take my second jeepney ride;

3. Notwithstanding diligent efforts, the said company ID could no

longer be recovered or located; hence, considered lost or destroyed for
all its intents and purposes;

4. I am executing this affidavit to attest to the loss of my

company ID, to attest to the truth of my foregoing statements and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

February 11, 2023 in the XXXXXXXXXXXXXXXX, Philippines.

XXXXXXXXXXXXXXXXXXXXXX
Affiant
TIN: XXXXXXXXXXXXXXXX

SUBSCRIBED AND SWORN to before me this February 11,

2023 in the XXXXXXXXXXXXXXXXXX, Philippines, affiant personally
appeared and exhibited to me her identification as above-indicated.

Doc No. : __________;

Page No.: __________;
Book No.: __________;
Series of 2023.