Republic of the Philippines)

City of Puerto Princesa) S.S

AFFIDAVIT OF LOSS

I, RAUL P. MEDIANERO, of legal age, Filipino, married and a resident of Block 3,

Hagedorn Road, Bgy. San Miguel, Puerto Princesa City, Palawan, after being duly
sworn in accordance with law, depose and state:

1. THAT I am the branch manager of CQB Security Agency Puerto Princesa

City Branch;

2. THAT MARIA HADAZA LLADO is currently employed as security guard of

CQB Security Agency;

3. That the duration/inclusive dates of her detail is from June 1, 2017 to July 1,
2017 at Caltex Rizal, Puerto Princesa City, Palawan;

4. That during the said period, CQB Security Agency issued agency/company
firearms which is particularly described as follows:

MAKE: ARMSCOR CALIBER: 38

KIND: RVLVR SERIAL NO.: 1517450

5. That she used to carry the abovementioned firearm during her duty at Caltex
Rizal, Puerto Princesa City;

6. That sometime in June 6, 2017, she left the said firearm on her post desk
drawer at Caltex Rizal, Puerto Princesa City;

7. That on the same date, when she look back to locate the said firearm, she
discovered that it was missing;

8. That despite diligent search and efforts to locate the abovementioned firearm,
she could not find the same such that she now have reasons to believe that it
is now lost beyond recovery.

9. As such, I am executing this Affidavit to attest to the truth of the foregoing and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affix my signature this

_________________________________ at Puerto Princesa City, Palawan.

RAUL P. MEDIANERO
Affiant
____________________________

SUBSCRIBED AND SWORN to before me this

________________________________ at Puerto Princesa City, Palawan, affiant
exhibited to me her competent proof of identity as shown below her name.

Doc No. ________;

Page No. _______;
Book No. _______;
Series of 2017.