REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC )S.S.

CITY OF TARLAC )

AFFIDAVIT OF LOSS
I, EDWIN LAMBERTO Z. ARGAMINO of legal age, single, Filipino
citizen, and resident and with postal address at MC Arthur Hi-way, San
Rafael Tarlac City do hereby depose and say:

1. That I am the holder/ owner or possessor of my original

company pay slip for the month of March, 2018;

2. That I have recently discovered that the said item is

irretrievably lost and to the best of my knowledge, can no
longer be found despite diligent efforts to locate the same;

3. That the said company pay slip has not been confiscated by
any officer of the law or the issuing officer or agency due to the
violation of any law, statue, order, rule or regulations;

4. That I hereby attest to the truth and veracity of the above-stated

statements and facts.

5. That I am executing this affidavit to attest to the truth of the

foregoing statements.

IN WITNESS WHEREOF, I have hereunto set my hand this

________at Tarlac City, Philippines.

EDWIN LAMBERTO Z. ARGAMINO

Affiant

SUBSCRIBED AND SWORN to before me this, _________at Tarlac

City, Philippines.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2018.