Affidavit of Loss Zone Pass

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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE )
MUNICIPALITY OF TANZA )

AFFIDAVIT OF LOSS

   I, LIEZL ABADINES DE OCAMPO, of legal age, Filipino, single and a


resident of 178 Biga, Cavite, after having been duly sworn to in accordance with
law, depose and state THAT:
1. I was issued a Company ID by JAE Philippines Inc., for me to be able to
enter its premises and go to work and issued a RCBC ATM Card;

2. That sometime on November 2020, I was on my way home when I


discovered that my wallet, which I inserted on my bag was missing;

3. My wallet contained some cash and the said, company ID and my ATM
card;

4. Efforts were exerted to locate said wallet, but in spite of diligent search,
it could not be found and the same is now beyond recovery;

5. I hereby declare under oath that the aforesaid company id was indeed
lost.
That in order to allow me to enter the company premises, I am executing this
Affidavit of Loss to attest to the truth of the foregoing and to support my
application for the issuance of a new company ID and RCBC ATM card in lieu of
the one that lost;

IN WITNESS WHEREOF, I have hereinto set my hand this 27th day of


March 2021 in Municipality of Tanza, Cavite, Philippines.

__________________________
Liezl A. De Ocampo

SUBSCRIBED AND SWORN TO BEFORE me this 27th day of March


2021 in Municipality of Tanza, Cavite, Philippines. Affiant exhibiting me her
UMID ID with no. CRN 011-4208121-6. With photograph and signature through
which I had been able to confirm her identity.

Doc. No.________
Page No.________
Book No.________
Series of 2021

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