REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA ) S.S.

x--------------------------------------------x

AFFIDAVIT OF LOSS

I, MOISES C. PAGADUAN, of legal age, Filipino, married and a resident of

Purok 9, Pantoc, San Juan City, after having been duly sworn to in accordance with law,
depose and state that:

1. I am a holder of an Employee Identification Card issued by the

Department of Labor and Employment (DOLE).

2. I have recently discovered that the said Identification Card is

irretrievably lost and can no longer be found despite diligent efforts to
locate the same;

3. As such, I am executing this Affidavit of Loss to attest to the truth of

the foregoing and to support my request for its replacement with the
DOLE- Human Resources Development Service.

IN WITNESS WHEREOF, I have hereunto set my hand this

___________________ in Manila, Metro Manila, Philippines.

MOISES C. PAGADUAN
Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his Firearm License Card with
ID No. FA-20398-7 issued by Philippine National Police with expiry on 02 October 2021
as his competent evidence of identity.

Doc. No. _____;

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