Republic of the Philippines) of

Batangas )s.s.
X X

AFFIDAVIT OF LOSS

I, JAPIE E. ZAPANTA, Filipino, single, of legal age, resident of Barangay Santiago

Malvar, Batangas, Philippines, after having been sworn by law hereby depose and state
that:

1. I am the owner of an ID issued by Yamaha Motor Philippines.

2. Sometime around 2:00 pm March 26, 2024, I lost the above Identification card under the
following circumstances:

3. Despite diligent efforts exerted, I could not locate or recover the said Identification card,
and to the best of my knowledge, the same is truly lost.

4. The said ID card has not been confiscated by any officer of the law or the issuing agency
or office due to the violation of any law, statute, order, rule, or regulation.

5. If the lost ID card should hereafter be found or located, I undertake to forward or

surrender the same to the company for appropriate disposal.

6. I am executing this affidavit to attest to the truth of the foregoing and to request the
issuance of a new ID card to replace the one that was lost.

SUBSCRIBED AND SWORN to before me on this 1st day of April 2024, in Malvar,
Batangas Philippines.

JAPIE E. ZAPANTA
Affiant
Issued ID: National ID
ID No.: 6285-6386-4716-5806

Doc. No. ;
Page No. ;
Book No.
; Series of 2024.