Republic of the Philippines}

City of Makati} S.S.

AFFIDAVIT OF LOSS

I, JOEBERTO E. EJANDRA , of legal age, married, with residence and postal address at
Blk. 54 Lot 21, Duhat St., Zone 1 Brgy. Rizal, Pembo, Makati City, after being sworn to
in accordance with law, depose and say that:

1) I am an employee of ASIATRANS INTERNATIONAL, INC. (AII), with office

address at the 6 th Floor, Country Space 1 Bldg., Sen. Gil Puyat Avenue, Makati City;

2) As such, I was provided by our employer with several Identification Cards such as our
Company ID, PHILHEALTH ID, BPI ATM CARD and I was likewise required to
procure our SSS Identification Card;

3) In my everyday way to and from the office, I used to drive my personal service
motorcycle with my wallet tucked in the back pocket of my pants;

4) However, last December 16, 2005, after arriving from office, I was just surprised to
have known that my wallet containing all my important IDENTIFICATION CARDS,
was already missing as it might have accidentally fell-off from the back-pocket of my
pants then while I was driving my motorcycle on my way to office during that day;

5) Diligent efforts have already been exerted to locate and/or retrieve my wallet along
with my IDs, but all turned out futile;

6) I have to request for the re-issuance of these new IDENTIFICATION CARDS (SSS
ID, PHILHEALTH ID, ATM CARDS, CREDIT CARDS, etc.) in furtherance of my
personal transactions and such other business transactions which may require the
presentation of those aforementioned missing IDs;

7) This affidavit is being executed to attest to the veracity of the foregoing facts and for
whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

December 21, 2005, Makati City.

JOEBERTO E. EJANDRA

Affiant SUBSCRIBED AND SWORN to before me this ___ day of ______________ at

____________, Philippines, affiant exhibiting to me his CTC # _________________,
issued at Makati City, on

NOTARY PUBLIC

DOC. NO._____;
PAGE NO._____;
BOOK NO._____;
SERIES OF 2017.