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Republic of the Philippines )

City of Santa Rosa, Laguna ) S.S.

AFFIDAVIT OF LOSS

I, RICO G. PANOPIO, of legal age, married, Filipino, and a


resident of Barangay Mamplasan, Binan , Laguna, hereby depose
and state:

1. That I am an employee of Pozzolanic Philippines, Inc.;

2. As such employee, I was issued a company trailer truck


RFID card with Plate No. WAF 166 and Plate no. WEI 995 ;

3. That last June 2016, I noticed that the trailer truck RFID
cards were misplaced and missing;

4. That despite diligent efforts to locate said RFID cards, I


could not find the same and I consider the same lost
beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to


the truth of the foregoing and to support the application for
the issuance of a new one in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto affixed my


signature this 10th day of October 2016 in the City of Santa Rosa,
Laguna.

RICO G. PANOPIO
Affiant

SUBSCRIBED AND SWORN to before me, in the City of


Santa Rosa, Laguna, this 10th day of October 2016 the affiant
exhibiting his UMID ID No. CRN-0004-1430400-4.

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