REPUBLIC OF THE PHILIPPINES)

PROVINCE OF NUEVA ECIJA )

CITY OF CABANATUAN )S.S.
X---------------------------X

AFFIDAVIT OF LOSS

I, ALVIN BRIAN G. VALDEZ, of legal age, Filipino, single and a resident of Brgy.
San Juan, Aliaga, Nueva Ecija, after having been duly sworn to in accordance with law hereby
depose and say:

1. That I am an employee at SM Cabanatuan City, Nueva Ecija;

2. That I am a holder of SM ID PASS issued by SM Cabanatuan City;

3. That on March 13,2020 at around 6:00 in the evening, I was driving my

motorcycle at Vergara Highway, when I discovered that my SM ID PASS is
missing, possible that it fell somewhere while I was driving;

4. That despite diligent search to locate my SM ID PASS it can no longer be found

hence it was deemed lost;

5. That I am executing this affidavit to attest to the truth of the foregoing and to
report this matter to the authorities because maybe it can be used to any illegal act
and for whatever legal intents and purposes it may serve.

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

_____________ 2020, here at Cabanatuan City.

ALVIN BRIAN G. VALDEZ

Affiant

SUBSCRIBED AND SWORN to before me this ___ day of ______________ 2020,

here at Cabanatuan City.

Doc. No. ______;

Page No. ______;
Book No. _____;
Series of 2020.