AFFIDAVIT OF LOSS of CARD

REPUBLIC OF THE PHILIPPINES)

CITY OF pasig
) S.S.
I, , an , after having been sworn in accordance with law
hereby depose and state:
That I am an expatriate employee of, Inc. and as such I am a
holder of Investors Card issued by the DOLE-calabarzon);
That sometime in July 14, 2014 (Monday), when I arrived
home from work, I discovered that my small pouch containing
my Investors Card and my Indonesian issued ATM Card was no
longer in the place where I used to put it and could no longer be
found;
That I took pains to look for said small pouch containing my
card
That I am executing this affidavit to attest to the truth of the
foregoing and to request the DOLE-NCR of issuance of a
replacement Card.
IN WITNESS WHEREOF, I have hereunto set my hand this
24 day of July, 2014 in the City of pasig.
th

Affiant
SUBSCRIBED AND SWORN to before me, this 24th day of
July, 2014, in the City of Manila, with affiant exhibiting her issued
by KBRI Manila on September 20, 2010.

Doc. No.:_________;
Page No.:_________;
Book No.:_________;
Series of 2014