REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE ) S.S.

MUN. OF GEN. M. ALVAREZ

AFFIDAVIT OF LOSS
I, CINDERELLA GALIT OLFATO, of legal age, Filipino, Single, with residence and postal address at
Brgy. Kaong, Silang, Cavite, after having duly sworn to in accordance with law hereby dispose
and state:
THAT
1. I am currently employed at Philippine Yushin Inc., as Human Resources Admin.

2. I was issued a Claim Slip with reference number R-011117-L-01 by Philippine

Economic Zone Authority.

3. The said document was lost while in my possession;

4. And despite earnest efforts to recover the same all proved futile and beyond recovery,
thus, considered as lost.

5. I shall assume the responsibility or liability if in event I will use these documents for
whatever illicit transaction;

6. I am executing this affidavit of lost to prove the truthfulness of all the allegations set
forth herein and for whatever legal purpose/s this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 26th day of April 2019,
at Gen. Mariano Alvarez, Cavite.

CINDERELLA G. OLFATO
Affiant

SUBSCRIBED AND SWORN TO before me this 26th day of April 2019, at Gen. M.
Alvarez, Cavite, Philippines, affiant exhibiting her SSS ID with number 33-56198618.

Doc. No.: __________

Page No. __________
Book No.__________
Series of 2019.
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF CAVITE ) S.S.
MUN. OF GEN. M. ALVAREZ

AFFIDAVIT OF LOSS

I, FEDERICO JR. R. PASCO, of legal age, Filipino, single and resident of Brgy. Maguyam, Silang,
Cavite Cavite, after having duly sworn to in accordance with law hereby dispose and state:

1. That I applied for Philippine Passport on December 22, 2017 at DFA NCR South with
receipt 3209787.

2. That sometime in January 2018, I lost the wallet where I put some of my belongings and
identification including the said Passport Receipt from DFA;

3. That it could have been misplaced and eventually got lost;

4. That I did fervent effort to recover my said wallet with the Passport Receipt proved
futile;

5. That I am executing this affidavit to attest to the truth of the foregoing and for all legal
intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____________

at Gen. Mariano Alvarez, Cavite.

FEDERICO JR. R. PASCO

Affiant
Company ID # 429

SUBSCRIBED AND SWORN to before me this ______________ at Gen. M. Alvarez, Cavite

affiant exhibiting to me his competent proof of identity with numbers indicated below his
name.

DOC. NO. __________

PAGE NO. __________
BOOK NO.__________
SERIES OF.__________

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE ) S.S.
MUN. OF GEN. M. ALVAREZ

AFFIDAVIT OF LOSS

I, DAISUKE SHIBAKUSA, of legal age, Japanese national, single and resident of Canyon Ranch,
Carmona, Cavite, after having duly sworn to in accordance with law hereby dispose and state:

1. That I, the General Manager Of Philippine Yushin Inc. with office address at Daiichi
Industrial Park-SEZ, Brgy. Maguyam, Silang, Cavite, instructed the Production Manager
to dispose the old Lathe Machine which is not functioning at all.

2. That last August 5, 2014, I ask the Accounting and Admin department to search for the
document of the said machine that as far as I remember arrived sometime in July 2000
for our full operation, and found out that the same was missing and nowhere to be
found.

3. That it could have been misplaced and eventually got lost;

4. That we did fervent effort to recover that said document;

5. That I am executing this affidavit to attest to the truth of the foregoing and for all legal
intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____________

At Gen. Mariano Alvarez, Cavite.

DAISUKE SHIBAKUSA
Affiant
Passport # TH8754046
Valid until March 17, 2019

SUBSCRIBED AND SWORN to before me this ______________ at Gen. M. Alvarez, Cavite

affiant exhibiting to me his competent proof of identity with numbers indicated below his
name.

DOC. NO. __________

PAGE NO. __________
BOOK NO.__________
SERIES OF.__________
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF CAVITE ) S.S.
MUN. OF GEN. M. ALVAREZ

AFFIDAVIT OF LOSS

I, DAISUKE SHIBAKUSA, of legal age, Japanese national, single and resident of Canyon Ranch,
Carmona, Cavite, after having duly sworn to in accordance with law hereby dispose and state:

1. That I am a holder of Alien Employment Permit ID with Permit No. RO4A2013070915

issued to me by the Department of Labor and Employment, Laguna;

2. That sometime in June 2014, when I was about to check and make an inventory of the
said Alien Employment Permit ID, I found out that the same was missing and nowhere to be
found;

3. That it could have been misplaced and eventually got lost;

4. That I did fervent effort to recover my said AEP ID proved futile;

5. That I am executing this affidavit to attest to the truth of the foregoing and for all legal
intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____________

at Gen. Mariano Alvarez, Cavite.

DAISUKE SHIBAKUSA
Affiant
Passport # TH8754046
Valid until March 17, 2019

SUBSCRIBED AND SWORN to before me this ______________ at Gen. M. Alvarez, Cavite

affiant exhibiting to me his competent proof of identity with numbers indicated below his
name.

DOC. NO. __________

PAGE NO. __________
BOOK NO.__________
SERIES OF.__________
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF CAVITE ) S.S.
MUN. OF GEN. M. ALVAREZ

AFFIDAVIT OF LOSS

I, CINDERELLA GALIT OLFATO, of legal age, Filipino, single and resident of Kaong, Silang, Cavite,
after having duly sworn to in accordance with law hereby dispose and state:

1. That I am a holder of Social Security System ID with No. 33-5619861-8 issued to me by

the Social Security System, Quezon City on 2006;

2. That sometime in June 2015, when I was about to check and make an inventory of the
said Social Security System ID, I found out that the same was missing and nowhere to be found;

3. That it could have been misplaced and eventually got lost;

4. That I did fervent effort to recover my said Social Security System ID proved futile;

5. That I am executing this affidavit to attest to the truth of the foregoing and for all legal
intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____________

At Gen. Mariano Alvarez, Cavite.

CINDERELLA G. OLFATO
Affiant
TIN ID # 214-456-537-000
Issued on May 7, 2015

SUBSCRIBED AND SWORN to before me this ______________ at Gen. M. Alvarez, Cavite

affiant exhibiting to me his competent proof of identity with numbers indicated below his
name.

DOC. NO. __________

PAGE NO. __________
BOOK NO.__________
SERIES OF.__________