Republic of the Philippines )

_____________________ ) S.S.

AFFIDAVIT OF LOSS

I, JERICHO ANTONIO SERAFINO, Filipino, of legal age, single, and a resident

of Doña Crispina, Home Agnaya, Plaridel, Bulacan, after being duly sworn to in
accordance with law, hereby depose and state that:

1. That I am an employee of HARMO TECHNOLOGY CORPORATION located

at First Cavite Industrial Estate (FCIE), Brgy. Langkaan II, Dasmariñas City,
Cavite.

2. Sometime in the Second Week of May 2018, when I was searching for my
HARMO TECHNOLOGY CORPORATION EMPLOYEE ID, I failed to find the
same despite diligent efforts to locate it.

3. I surmised that I inadvertently misplaced the aforementioned EMPLOYEE ID

in our house or could have accidentally dropped the same somewhere.

4. The aforementioned EMPLOYEE ID could now be deemed completely lost

and beyond recovery by the reason of the above-cited circumstance.

5. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing statement in order to secure a replacement of the same and for
whatever legal intents and purposes this may serve.

AFFIANT FURTHER SAYS NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this

___________________ at ________________________, Philippines.

JERICHO ANTONIO SERAFINO

Affiant

SUBSCRIBED AND SWORN to before me, this __________________, by the

affiant whom I have identified through Competent Evidence of Identity when he exhibited
to me his PhilHealth ID with No. 21-251884223-1.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.