EPUBLIC OF THE PHILIPPINES) City of Makati ) S.S. x - - - - - - - - - - - - - - - - - - - - - - - x
AFFIDAVIT OF LOSS I, REGGIE C. BALTAZAR , Filipino, of legal age, married, and with office address at 7/F Pacific Star Bldg., Sen. Gil Puyat Ave. cor. Makati Ave., Makati City, Philippines, after being duly sworn in accordance with law, depose and state: 1. That I am the Billing and Collection Department Head of HACIENDA HACIENDA MACALAUAN, INC., a corporation duly organized and existing under and by virtue of the laws of the Republic of the Philippines; 2. That being given given the above-mention above-mentioned ed position, it is my responsibilit responsibility y to receive and keep in my custody Counter Receipts issued by Supermarket Supermarket in favor of our Company; 3. That sometime in March 2013, the original copy of COUNTER RECEIPT No. 032749 dated February 27, 2013 which contains the following verified Sales Invoice: Sales Invoice No. 218951 218950 218949 Total
Amount Php 3,950.50 Php 4,266.34 Php 4,154.40 Php 12,371.24
could not be found and that despite of diligent search and efforts, the same could no longer be found such that I now believe that it is now lost beyond recovery. 4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and for whatever legal purposes that this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of May 2013 at Makati City, Philippines.
REGGIE C. BALTAZAR AFFIANT
SUBSCRIBED AND SWORN to before me, this 20th day of May by the Affiant who whom I have identified through competent evidence of identity and who exhibited her SSS ID No. 33-1213415-3 issued at Makati City on April 2006.
Doc. No. ______; Page No. ______; Book No.______; Series of 2013.
