Republic of the Philippines )
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AFFIDAVIT OF LOSS
I, ______________________ of legal age, Filipino, and a resident of 110 Camino St.
San Nicolas, Gapan, Nueva Ecija after having been duly sworn to in accordance with
law hereby depose and say:
That, I am the former employee at Informatics Professional Inc. as
Fund Owner Assistant and I was issued a corresponding company ID;
That, on April 17, 2017, my wallet containing said company ID was
stolen;
That I exerted all possible efforts to locate the same, but to no avail;
That I am executing this affidavit in order to attest to the truth of
the foregoing to request a new Policy in lieu of the lost one and for
whatever legal intents and purposes it may serve.
FURTHER AFFIANT SAYETH NAUGHT.
IN TRUTH OF THE FOREGOING I have hereunto set my hand this 26th day of
May 2017, here at Cabanatuan City.
Affiant
SUBSCRIBED AND SWORN to before me this 26th day of May 2017, here at
Cabanatuan City.
Notary Public