Republic of the Philippines)

City of Batangas )
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AFFIDAVIT OF LOSS

I, Justine Joy B. Moog, 23, Filipino, single and a resident of Sorosoro Ibaba, Batangas City
Philippines, after having been duly sworn in accordance with law, hereby deposes and state:

1. That I am a holder of a Sorosoro Ibaba Development Cooperative(SIDC) Identification

Card(ID) issued by the Human Resource Department of SIDC;

2. That Sometime in June 14, 2018, I lost my SIDC ID under the following circumstances:
That around 5:30 in the afternoon of the same date at our Company Outing at
Malabrigo, Lobo Batangas, I discovered that my SIDC ID was no longer in my
backpack bag where I used to place it and that I might have inadvertently mislaid the
said SIDC IDC steering to its loss;

3. That despite diligent efforts exerted, I could no longer locate, find or recover the issued
SIDC ID, and to the best of my knowledge, the same is truly lost;

4. That said SIDC 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. That in the event that the lost SIDC ID should hereafter be found or located, I undertake
to forward or surrender the same to Human Resource Department of SIDC; and

6. That I am executing this affidavit to attest to the truth of the foregoing statement and
to request for the issuance of a new SIDC Identification Card in lieu of the one which
was lost.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ of June 2018 at
Batangas City, Philippines.

Justine Joy B. Moog

AFFIANT

SUBSCRIBED AND SWORN to before me this _________ day of June 2018, affiant
exhibited to me his competent evidence of identity by way of ________________________ issued
at ___________________________ on ________________________.

NOTARY PUBLIC

Doc No. __________ ;

Page No. __________;
Book No. __________;
Series of 2018.