REPUBLIC OF THE PHILIPPINES )

ZAMBOANGA CITY ) SS.

x-------------------------------------------x

AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

I, NAME, of legal age, single, and a resident of ADDRESS, after having been duly
sworn in accordance with law, hereby depose and say, that:

1. I am a holder of a Company Identification Card bearing ID number ______

issued by COMPANY NAME;

2. I used to keep said Company Identification Card in my wallet and the same
wallet is likewise kept inside my bag;

3. On DATE, (CIRCUMSTANCES-HOW IT WAS LOST)I went to Manila for

personal reasons and came back from Manila on DATE;

4. On DATE, (CIRCUMSTANCES-HOW IT WAS LOST) when I opened my

wallet to check for my identification card, I discovered that the same was no
longer inside my wallet;

5. I exerted diligent efforts to locate and search the same however, said
Identification Card was nowhere to be found and I might have lost it in
Manila;

6. The Identification Card was not confiscated by the COMPANY authorities for
any reason. Neither have I violated any company rules and regulations;

7. I am executing this affidavit to attest to the truth of the foregoing facts and to
request for a replacement of said Company Identification Card from
COMPANY NAME.

IN WITNESS WHEREOF, I have hereunto affixed my signature on the

date and at the place appearing hereunder.

AFFIANT NAME
Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of MONTH AND YEAR, at
Zamboanga City, Philippines, affiant NAME, exhibited to me her competent evidence of
identity her COMPETENT EVIDENCE OF IDENTITY(SEE NOTARIAL LAW) issued
at Zamboanga City.

Doc. No. ____

Page No. ____
Book No. ___
Series of 2017