Republic of the Philippines)

City of Pasig…………………) s.s

AFFIDAVIT OF LOSS

I, EDGAR MAGPUSAO, of legal age, Filipino, with business address in # 8522

Sandoval Avenue, Pinagbuhatan, Pasig City, after having been sworn in accordance with
law do hereby depose and state:

1. That I am the authorized representative of PREMIER READY-MIX INC.,

doing business at address stated above;

2. However Original Copy of RFID Card with account no. 125723 (Truck No.
205; Plate no. TDQ 653) was missing presumably misplaced and nowhere to be
found for unknown circumstances;

3. That despite diligent search and effort to locate the same but proves to be of no
avail;

4. That I am executing this affidavit to attest to the veracity of the foregoing facts
and for whatever legal purpose it may serve;

IN WITNESS WHEREOF, I have hereunto set my hands this _____ day

of ______________, 2018 at Pasig City.

_____________________________
Edgar Magpusao
Affiant

SUBCRIBE AND SWORN to before me this ______day of _____________, 2018 at

Pasig City, Philippines, affiant exhibiting to me his/her competent evidence of
identity by way of __________________ issued at ___________on
_______________.

Doc. No. __________

Page No. __________
Book No. __________
Series of 2018