Republic of the Philippines)

City of _______________)S.S

AFFIDAVIT OF LOSS

I, VAN RAINEER GARCIA, of legal age, Filipino and a resident of

Bagongpook, Lipa City, Batangas, after having duly sworn to, in accordance
with law, do hereby depose and state that:

1. I was in possession of a cellular phone with a Globe Sim Card

(Prepaid) with cellphone number: 09176646180;

2. Sometime in January 2023, I attended a meeting in a forum room.

Customarily, I placed the phone on the table;

3. Unfortunately, I forgot to take the phone with me after the

meeting. Upon realizing that I did not have it with me, I
immediately returned to the forum room. However, I did not find it
on the table where I placed it;

4. That despite diligent search and efforts to locate said cellular

phone, I could not find the same such that I now believe that said
is now lost beyond recovery together with the aforesaid SIM Card;

5. As such, I am executing this Affidavit of Loss to attest to the truth

of the foregoing and in support of my request / application for the
replacement of the said SIM Card.

6. To process my quitclaim and collect my last payroll salary and

other benefits in cash or in check at Nestle Philippines,
Bagongpook, Lipa City;

7. To execute and process the necessary documents required for the

collection of said compensation and benefits due me, and sign any
and all documents and papers, including quitclaim forms, as well
as claim/receive for and in my behalf said documents from the
said company, as well as to do any and all acts in order to
accomplish the afore-stated acts and deeds;

IN WITNESS WHEREOF, I hereby set my hand this ___ day of

February in _______ City, Philippines.

VAN RAINEER GARCIA

Affiant
  SUBSCRIBED AND SWORN TO before me this ___ day of
February in ________ City, affiant exhibiting to me his competent evidence
of identity by way of government ID.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____.