REPUBLIC OF THE PHILIPPINES )

CITY OF MANDAUE
) S.c.
AFFIDAVIT OF LOSS
I, JACQUILOU C. ATUP, of legal age, Filipino and a resident of
Maguikay, Mandaue City, after being sworn to in accordance with law,
depose and say that:
1.
I was previously issued a company ID by Profoods
International, Inc.;
2.
pocket;

I used to keep the above-mentioned evidence of identity in my

3.
Yesterday, while I was on my way to my workplace, I
accidentally left the said ID;
4.
find it;
5.

I tried all efforts to locate the subject ID but I was not able to
The ID is now beyond recovery; and

6.
I am executing this sworn statement, as required, to enable me
to obtain a replacement for the said lost document.
IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day
of May 2015, in the City of Mandaue, Philippines.

JACQUILOU C. ATUP
Affiant
JURAT
SUBSCRIBED and sworn to before me, this 30th day of May 2015, in
the City of Mandaue by affiant with the following competent evidence of
identity:
Evidence of Identity
ID Number
NBI
Clearance A310JJUU19(29499793)
JM128775

Validity Date
March 10, 2016

Issued At
NBI-Cebu

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2015.
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