REPUBLIC OF THE PHILIPPINES )

__________________________) S.S.

AFFIDAVIT OF LOSS
I, ________________, of legal age, Filipino, single, and presently residing
at__________________________, having been duly sworn in accordance with the
law, hereby depose and state the following:

1. That I affirm that I am the rightful holder of a Company ID issued to

me bearing the name ______________________with ID
number____________________;

2. That on December 1, 2023, regrettably, my Company ID was

misplaced and subsequently lost within the premises of
_____________________________________at the 2nd floor of the building.
Despite thorough and diligent efforts, I have been unable to locate or
recover the aforementioned Company ID;

3. That I affirm that the loss of my Company ID occurred beyond my

control, and to the best of my knowledge and belief, there was no
deliberate or malicious intent involved in its disappearance; and

4. That I execute this affidavit to attest to the truthfulness of the

foregoing information, and to facilitate the procurement of another
Company ID, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

__________, 2023 at_________________.
______________________
Affiant

SUBSCRIBED AND SWORN to before me this _____________ at________________,

Philippines. I hereby certify that I personally examined the affiant and that I
am satisfied that she voluntarily executed and understood this affidavit. Affiant
presented to me her ___________________bearing numbers___________________as
competent proof of her identity.

Doc No.: ___

Page No.: ___
Book No.: ___
Series of 2023.