REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAVITE ) S. S.
MUNICIPALITY OF TANZA )

AFFIDAVIT OF LOSS

I, ROLANDO A. IKAN, of legal age, Filipino, married and a resident of

102A San Juan Street, Barangay Poblacion I, Tanza, Cavite, after having been
sworn in accordance with law, hereby depose and state that:

1. I am employee of SM CITY, Barangay Habay, City of Bacoor,

Cavite;

2. On November 13, 2017, while I was driving along the hi-way of

Bacao, within the jurisdiction of the Municipality of General Trias City,
Province of Cavite, I discovered to my surprise that my company
identification card with control number 202430-6 issued by the aforesaid
company is no longer in my possession and is missing;

3. The circumstances leading to the loss of said card have not been
determined;

4. Up to this day, the whereabouts of said card remained unknown

despite diligent efforts to recover the same and the same may now be
considered lost for all intents and purposes;

5. I am executing this affidavit to attest to the foregoing facts and for

the purpose of reporting the fact of loss of said card to the company, to secure
the issuance of another in lieu of the lost one and for any legal purpose this
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of

November, 2018 in the Municipality of Tanza, Province of Cavite, Philippines.

ROLANDO A. IKAN
Affiant

SUBSCRIBED AND SWORN to before me this 15th day of November,

2018 in the Municipality of Tanza, Province of Cavite, Philippines affiant
exhibiting to me his Driver’s License ID NO: DO6-06-005216 with photograph
and signature through which I had been able to confirm his identity.

ATTY. JASON ALMOND P. DE GUZMAN

Notary Public-Province of Cavite
Commission Expires Dec. 31, 2018
IBP Roll No. 61387
MCLE No. V– 0012037; 12-02-15
PTR No. 9948313; Cavite; 1-05-18
IBP No. 1062693; PPLM; 01-03-18

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.