Republic of the Philippines )

Dasmariñas City, Cavite ....) S.S.

AFFIDAVIT OF LOSS

I, ACE LEXBY STA. MARIA PEDROCHE, of legal age, Filipino, married, and a
resident of #084 ME Antonio Street, Batas, Silang, Cavite, after being sworn to in
accordance with law, hereby depose and state:

1. That I am hired by the employment agency JINZAI EXPERT and has been
assigned to YUMEX PHILIPPINE CORPORATION located at First Cavite
Industrial Estate (FCIE), Dasmariñas City, Cavite.

2. That on 21st December 2010, I rode a bus on my way to my workplace.

However, when I reached the premises of FCIE in Dasmariñas City, Cavite, I
found out that my company (Yumex Philippine Corporation) Identification Card
(ID) is missing or nowhere to be found.

3. I surmised that said ID could have been accidentally dropped when I was on
board the bus.

4. I tried to diligently search for it but my effort proved futile as I failed to locate
the same. Hence, said ID is deemed completely lost and beyond recovery.

5. I am executing this affidavit to secure a replacement of the same and for

whatever legal intents and purposes it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

ACE LEXBY S. PEDROCHE

Affiant

SUBSCRIBED AND SWORN to before me this _____ day of January 2011 at

Dasmariñas City, affiant exhibiting to me his PHILHEALTH ID NO. 08-050831236-2.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2011.