REPUBLIC OF THE PHILIPPINES)

CEBU CITY) SS

AFFIDAVIT OF LOSS

I, DEAN LAWRENCE M. OTERO, of legal age, single, residing at Agus, Lapu-

Lapu City, Philippines, after being sworn in accordance with law, depose and say:

1. That I am the lawful owner of the Company ID issued by Qualfon Cebu;

2. That I usually kept the abovementioned item inside my bag for safekeeping.

3. However, sometime on May 9, 2023, around 3:00 o’clock in the morning, I

noticed that the abovementioned item was already missing from my bag, and
it might have fallen out while I was traveling;

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

5. I am executing this affidavit to attest to the truth and veracity of the foregoing
facts so that I may be issued a new Company ID in lieu of the lost one, and for
whatever legal purpose this may serve.

IN WITNESS WHEREFORE, I have hereunto affixed our signature this

________________________, at Cebu City, Philippines.

DEAN LAWRENCE OTERO

Affiant
3976-8132-9648-5406
Philippine Identification Card

SUBSCRIBED AND SWORN to before me, a notary public for and in the City of
Cebu, this ________________________ at Cebu City; affiant who personally appeared
before me with their competent evidence of identity above, and who signed this
instrument in my presence, and avowed under the penalty of law to the whole truth
of its contents.

WITNESS MY HAND AND SEAL on the date and at the place above-written.

Doc.No._____;
Page No.____;
Book No.____;
Series of 2024.