Republic of the Philippines )

Batangas City ) S. S.

AFFIDAVIT OF LOSS

I, FRANCISCO I. CANONOY, of legal age, married and a resident of Plaza Burgos,

Balayan, Batangas, after having been sworn to in accordance with law, hereby depose and
state that:

1. I am licensed meat handler. I work for Citimart Batangas.

2. In relation to my work, I was issued by the City Government of Batangas a Meat

Handlers License with ID No. 329. I also was issued a company ID by my employer
Citimart Batangas and a Health Card.

3. I kept the said Meat Handlers ID, Company ID and health card in my bag as I often
use it in my work.

4. Last December 15, 2017, I noticed that my IDs were missing from my bag. It might
have been lost when I travelled from Batangas to Balayan.

5. I exerted all diligent efforts to locate my Meat Handlers ID, Company ID and health
card but to no avail. I looked over in and out my bag but I could not find the same.

6. I am executing this affidavit to attest to the truth of the foregoing facts for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

__________________ at Batangas City, Philippines.

FRANCISCO I. CANONOY
SSS ID No. 04-3478474-3

SUBSCRIBED AND SWORN TO before me this _______________________ at

Batangas City, Philippines by the affiant whom I have identified through competent
evidence of identity printed below her name and signature.

Doc No. ______;

Page No. _____;
Book No. _____;
Series of 2017