REPUBLIC OF THE PHILIPPINES

MALAYBALAY CITY

AFFIDAVIT OF LOSS

I, MARIA JANE GONZALES, of legal age, single, Filipino, with

residence at Zone 4, Kalasungay, Malaybalay City, after having been sworn
to in accordance with law hereby dispose and state that:

1. I am an employee of Gaisano Mall. As such, I was issued an

Employee ID.

2. On January 10, 2021, while I was on my way home I encountered a

snatching incident where all my belongings including my Employee
ID was snatched.

3. I resorted to any means possible to restore possession of even just

my IDs, but it was of 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 4 th day

of March 2021 at Malaybalay City, Bukidnon, Philippines.

MARIA JANE GONZALES

Affiant

SUBSCRIBED AND SWORN to before me this 4th day of March

2021 in Malaybalay City, Bukidnon, Philippines. Affiant exhibited to me her
competent evidence of identity as MARIA JANE GONZALES.

Notary Public

Doc. No. 1234;

Page No. 5678;
Book No. 910;
Series of 2021