Republic of the Philippines) of

Batangas )s.s.
X X

AFFIDAVIT OF LOSS

I, MAE ANN M. MAGTIBAY, Filipino, single, of legal age, resident of #139 Sitio
Jasmin, Tumbaga 2, Sariaya ,Quezon, Philippines, after having been sworn by law
hereby depose and state that:

1. I am the owner of a Company ID issued by EPSON Precision Philippines, Inc., Lima

Brgy. Santiago Malvar, Batangas;

2. Sometime around May 7, 2024, in an unexpected situation I missed my ID and I’m not
sure if I lost it in our company or the shuttle, I lost the above company ID under the
following circumstances;

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

4. The said company ID, 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 company ID should hereafter be found or located, I undertake to forward or

surrender the same to the company where I worked 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 company ID to replace the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 9th of May, 2024, in Malvar,
Batangas, Philippines.

MAE ANN M. MAGTIBAY

Affiant
Issued ID: National ID
ID No. 2419-0891-6712-8174

SUBSCRIBED AND SWORN to before me on this 9th day of May 2024, in Malvar,
Batangas Philippines.

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