REPUBLIC OF THE PHILIPPINES)

CITY OF LAOAG )S.S

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

AFFIDAVIT OF LOSS
I, ROMEO JR ANGELES GONZALES, of legal age, single and residing at BRGY
SAN JUAN, PANTABANGAN, NUEVA ECIJA after having been duly sworn to
according to law hereby depose and state:
1. That I am currently working for North East Power Corporation; and I was
assigned at National Grid Corporation of the Philippines;
2. That I was issued an Access Pass Identification Card by said Institution;
3. That said Identification Card was missing since August 5, that I believed I
may have misplaced it and got lost. Despite long and diligent search, it could
no longer be recovered.
4. That I am executing this affidavit in order to attest to the truth of the
foregoing circumstances and to support a request for replacement copy of the
above-mentioned Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 31 st day of August,

2023 at the City of Laoag.

_______________________
ROMEO JR ANGELES GONZALES
SUBSCRIBED AND SWORN to before me this 31st day of August, 2023
affiant exhibited a competent proof of their Identity: PIC: 5607-4612-5380-
4814 a Govt. Issued I.D. issued at Pantabangan, Nueva Ecija.

Doc. No. __________;

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