REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S. 
                                                     

AFFIDAVIT OF LOSS
 

I, JUAN DELA CRUZ, of legal age, single, Filipino, with residence at 1000 Big Ave.
Street, Novaliches, Quezon City, after having been sworn to in accordance with law
hereby depose and state that:
 
1. I am an employee of XYZ Corporation. As such, I was issued an Employee ID.

2. On 01 September 2020, while I was at the Trinoma Mall, my paper bag

containing valuable items and the aforementioned Employee ID was stolen.

3. I took pains to look for the said paper bag, but to no avail; hence, the same was
declared lost.

4. I execute this affidavit to attest to the truth of the foregoing, and to secure

another Employee ID, and for whatever legal purpose it may serve.

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

September 2020 at Quezon City Philippines.                 
                   

                                                                   JUAN DELA CRUZ

Affiant                        
        
 
      SUBSCRIBED AND SWORN to before me this _____ day of September
2020 in Quezon City Philippines. Affiant exhibited to me his competent evidence of
identity as __________________.

Notary Public

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2020.