REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) s.s.

MUNICIPALITY OF TAGO)

AFFIDAVIT OF LOSS OF EMPLOYMENT ID CARD

I, GIAN BRIAN COTANDA DACULO, Filipino, of legal age, single, and
a resident of Purok Kasamahan, Dawis, Tandag City, Surigao del Sur,
Philippines, after having been duly sworn to in accordance with law, depose
and state:
1.

That I am holder of an Employment Identification Card issued by

MEGA Fishing Corporation based at Cagayan de Oro City, being
a former employee of the said company;

2.

That said Identification Card was unfortunately lost and its

whereabouts cannot anymore be ascertained despite my diligent
search; and

3.

That I am executing this Affidavit of Loss to attest to the veracity

of the foregoing and in support for the release of my unclaimed
wages at MEGA Fishing Corporation.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 9 th

day of January, 2017 at Tago, Surigao del Sur, Philippines.

GIAN

BRIAN

COTANDA

DACULO
AFFIANT

SUBSCRIBED AND SWORN TO before me this 9th day of

January, 2017 at Tago, Surigao del Sur, Philippines. The identity of
the affiant is established by his UMID with CRN-0111-2469734-3.

ATTY. DANIEL L. DIAZ

Doc No.
Page No. 5
Book No. I
Series of

34

2017

NOTARY PUBLIC
Until December 31, 2017
Victoria, Tago, Surigao del Sur
PTR No. 6618008 01/06/17
IBP No. 1063365 01/09/17
TIN 295-753-777-000
ROLL NO. 57741
MCLE Compliance No. V-0013299