AFFIDAVIT OF LOSS

I, NAME, Filipino, married, and resident of Address City, after being duly sworn according to law, hereby depose and state that: 1. I am the holder of company ID with number 000000b issued by the Company . 2. Sometime in date, I lost the above company ID under the following circumstances:
When I arrived home from work, I discovered that my company ID was no longer in my pouch where I used to place it.

3. Despite diligent efforts exerted, I could no longer locate, find or recover the said Company ID, and to the best of my knowledge, the same is truly lost. 4. The said company ID has not been confiscated by any officer of the law or the issuing office or agency due to the violation of any law, statute, order, rule or regulation. 5. In the event that the lost company ID should hereafter be found or located, I undertake to forward or surrender the same to the company for appropriate disposal. 6. I am executing this Affidavit to attest to the truth of the foregoing statements of my lost company ID. AFFIANT FURTHER SAYETH NAUGHT. IN WITNESS WHEREOF, I have hereunto set my hand this ____________________ at _________________________. ____________________________ Affiant SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited to me his/her Competent Evidence of Identity by way of __________________ issued at ______________ on __________________. Doc. No. ______; Page No. ______; Book No. ______; Series of ______.