REPUBLIC OF THE PHILIPPINES)

CEBU CITY) SS

AFFIDAVIT OF LOSS

I, PENDY LYN CASAS, of legal age, single, residing at Triumfo Carmen, Cebu,
Philippines, after being sworn in accordance with law, depose and say:

1. That I am the lawful owner of the Agency ID issued by the Cebu General
Services, Inc..;

2. That I usually kept my Agency ID inside my pocket for easy access;

3. That sometime on February 15, 2022, on my way home from work, I noticed
that the abovementioned item was already missing from my pocket and it might
have fallen out of my pocket while I was travelling;

4. That I directly went back to my route and diligently exerted efforts to locate the
said Agency ID, but despite a diligent search it could not be found, hence the
same is deemed lost and at a point beyond recovery;

5. That the Agency ID said has not been encumbered, sold, pledge, assigned,
alienated, transferred, donated, or give as collateral for any debt or obligation to
or in favor of any person or entity;

6. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts so that I may be clear in the Agency in lieu of the lost one, and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this August 8, 2022,

in Cebu City, Philippines.

PENDY LYN CASAS

Affiant
CRN-0111-9722589-4
Unified multi-Purpose ID

SUBSCRIBED AND SWORN to before me this 8th day of August 2022 at Cebu
City, Philippines, affiant personally known to me with his competent evidence of
identity abovementioned to be the same person who executed the foregoing affidavit
and avowed, and who signed this instrument in my presence, and avowed under the
penalty of law to the whole truth of its contents.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2022.