REPUBLIC OF THE PHILIPPINES)

PASIG CITY ) S.S.

AFFIDAVIT OF LOSS

I, JAYWIN B. MALDECINO, of legal age, Filipino, single and a

resident of Lupang Arenda, Taytay, Province of Rizal, after having been
sworn in accordance with law, hereby depose and say:

1. That, I am an employee of Altair Global Solutions with address at

Mandaluyong City to which a company ID was issued by my
employer when I was hired;

2. That, I was issued with an Intellicare health card for our HMO
by Altair Global Solutions as part of my benefits as an employee;

3. On May 19, 2018, as I realized that the company ID and my

health card was not inside the pocket of my jacket anymore. I
backtracked my steps and I was only walking along Jelp Building in
Mandaluyong City when I reached for something in my jacket
pocket;

4. Despite efforts to attempt to retrieve and look for my company Id

and Intellicare Health Card, I could not locate them anymore;

5. I execute this Affidavit of Loss in order for me to secure a

replacement for my Company ID and Intellicare health card;

6. I am executing this affidavit to attest to the truth and veracity of

the foregoing facts and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 14 th day of

June, 2018 in the city of Pasig.

JAYWIN B.
MALDECINO
Affiant

SUBSCRIBED AND SWORN to before me this 14th day of June 2018 in

Pasig City, affiant having exhibited to me his Philhealth ID with ID No. 01-
051475075-6.

Notary
Public
Doc No.
Page No.
Book No.
Series of 2018