REPUBLIC OF THE PHILIPPINES) Quezon City, Metro Manila ) S.S.

AFFIDAVIT OF LOSS

That I, JAY V. BELTRAN, of legal age, Married, Filipino Citizen residing with postal address at 94 A. Luna st, San Juan City, Metro Manila after having been duly sworn to in accordance with the law do hereby depose and state; 1. That I am bonafide holder of COMPANY I.D. CARD issued to me; 2. That the said COMPANY I.D. CARD was lost on May 3o, 2011 due to misplaced in my possession I discovered lately that my said COMPANY I.D.is missing; 3. That diligent search retrieved or recovered but all my effort exerted prove futile; 4. That I am reporting this incident happened for whatever legal purpose it may serve; 5. That I am executing this Affidavit of Loss to attest to the truth and the veracity of the foregoing facts as my evidence on my part;

IN WITNESS WHEREOF, I affix my signature this 14th day of June, 2011 at Quezon city, Philippines.

JAY V. BELTRAN Affiant

SUBSCRIBED AND SWORN to before me this 14th day of June, 2011 at Quezon City, Philippines.

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