REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
C. R.
I, DEONYSON P. DY, representative of PD888 Distributors, Inc. , of legal age,
Filipino and presently residing at Carlos Hilado St., Brgy. Bata, Bacolod City, Negros
Occidental, after been dully sworn to in accordance with law, hereby depose and say;
1. That I am the registered Owner of a motor vehicle, more particularly describe
as follows:
Make & Type: Suzuki FK110D Motorcycle
Motor Number: E472103765
Chassis Number: BE4DX103765
Plate No.: 5672Qs
2. That the Original Certificate of Registration (C. R.) of above mentioned motor
vehicle was lost;
3. That I exerted diligent effort to recover the said documents but it proved
unavailing;
4. That the same document was not mortgaged to financing/banking institution
but nor confiscated or apprehended for any violation of LTO Laws of
ordinances;
5. That I am absolving LTO-Bacolod City District Office and all its Personnel of
any Civil, Criminal and Administrative liabilities that may arise in the future
regarding the issuance of the C. R. of the above mentioned vehicle;
6. That I execute this affidavit to prove the truth of all foregoing facts;
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
__________ 2016 at Bacolod City, Philippines.
DEONYSON P. DY
Representative of PD888 Distributors, Inc.
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2016 at Bacolod City, Philippines.
Doc. No._____
Page No._____
Book No._____
Series of 2016.
REPUBLIC OF THE PHILIPPINES )
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, SHER VAN A. CUSIO, of legal age, Filipino and a resident of St. Lorenzo Ruiz
Avenue, Doña Juliana Subd., Brgy. Taculing, Bacolod City, Philippines, after being duly
sworn to in accordance with law do hereby depose and say:
1. That I am the Logistics Head of PD888 Distributors, Inc., with office address
at Carlos Hilado Highway, Barangay Bata, Bacolod City since March 30,
2016;
2. That as a Logistic Head, I am tasked to utilized and control overall orders
from Booking Salesman to deliver from designated accounts, check and verify
individual documents valid for deliveries, and documentations of receipts and
other documents for deliveries gathered from the accounts.
3. That on April 25, 2016, the original copy of Purchase Oder receipt from the
account Lopues Mandalagan with reference number No. 71211-15 dated April
25, 2016 with the total amount of P33, 823.80 from the receipt, were found to
be missing;
4. That despite diligent search and efforts to locate the said receipt, I could not
find the same that I now believe that it is lost beyond recovery;
5. That said Purchase Order receipt for countering collection have not been
collected from Lopues Mandalagan;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and to support my claims from Lopues Mandalagan, in lieu of the
ones that were lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
__________ 2016 at Bacolod City, Philippines.
SHER VAN A. CUSIO
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2016 by the Affiant whom I have identified
through competent evidence of identity: Unified Social Security System No.
CRN-001-1560739-7.
Doc. No._____
Page No._____
Book No._____
Series of 2016.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, MARK ANTHONY P. CAINA, of legal age, single and presently residing at
Purok Nami-nami 2, Brgy. Sum-ag, Bacolod City, Negros Occidental, after been dully
sworn to in accordance with law, hereby depose and say;
That I am a holder of a company ID card bearing serial number 88800185 issued
by PD888 Distributors, Inc.
That I used to put the said Identification Card in my wallet, among others;
That sometime on May 29, 2016, when I arrived home from going other places
while riding with my motorcycle, I discovered that my wallet with my company ID card
within was no longer in my pocket where I used to placed it;
That I might have inadvertently dropped the said wallet with my company ID
within while riding with my motorcycle;
That diligent effort to locate the same had proved futile;
That I am executing this affidavit to attest to the truth of the foregoing facts and to
request for a replacement of the said company ID card from PD888 Distributors, Inc.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
__________ 2016 at Bacolod City, Philippines.
MARK ANTHONY P. CAINA
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2016 by the Affiant whom I have identified
through competent evidence of identity: BUREAU OF INTERNAL REVENUE
TIN No. 279-561295.
Doc. No._____
Page No._____
Book No._____
Series of 2016.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, NONELON L. BAYDO, of legal age, married and presently residing at Purok Marapara
Zone II, Brgy. Bata, Bacolod City, Negros Occidental, after been dully sworn to in accordance
with law, hereby depose and say;
That I am a holder of a Driver’s License ID card bearing serial number F01-99-134307
issued by Land Transportation Office and TIN ID card bearing serial number 942-547-561
issued by Bureau of Internal Revenue.
That I used to put both said Identification Card in the wallet, among others in my
personal backpack;
That on June 15, 2016, I was the assigned driver for panel truck delivery and to deliver
Green Cross Products at Lopue’s Store Outlet San Sebastian branch located at Araneta
Avenue, San Sebastian St., Bacolod City, Negros Occidental.
That after I extract and prepared all items to deliver, I secure to lock the back door of the
panel truck before I leave and to manually hand-in all items to deliver to the said store but in that
moment i did not check or secure to lock the passenger’s door at the front of the panel truck
where I leave my personal backpack containing other things and my wallet with ID’s within due
to anticipation of the delivery and tight schedule to catch-up.
That after delivery I came back to the panel truck and I notice that my personal backpack
containing other things and my wallet with ID’s within was already gone and nowhere to be
found in the area where I parked the panel truck.
That diligent effort to locate the same had proved futile;
That I am executing this affidavit to attest to the truth of the foregoing facts and to
request for a replacement of the said both ID cards from Land Transportation Office and Bureau
of Internal Revenue.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
__________ 2016 at Bacolod City, Philippines.
NONELON L. BAYDO
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2016 by the Affiant whom I have identified
through competent evidence of identity: Social Security System ID No. 07-2241765-4.
Doc. No._____
Page No._____
Book No._____
Series of 2016.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, MARIKA JEAN N. JALANDO-ON, of legal age, married and presently residing
at L28 B55, East Homes II, Brgy. Estefania, Bacolod City, Negros Occidental, after
been dully sworn to in accordance with law, hereby depose and say;
That I am a holder of Social Security System Unified ID card bearing serial
number CRN: 000717994409 issued by Social Security System.
That I used to present and endorse the said Identification Card during store visit
and to follow-up Booking Collections of Colgate Palmolive accounts as per demand by
every store owners or accounting offices of the store for security purposes and standard
procedures to follow during inquiries;
That sometime on June 16, 2016, when I arrived in the office from going other
places during store visit, I discovered that the said Identification Card was no longer in
my wallet where I used to placed it and I didn’t even remember if I retrieve it from one of
the store I visit that day and I already asked and checked every store to verify and to
locate the said ID;
That I might have inadvertently dropped the said Social Security System Unified
ID within while on operation;
That diligent effort to locate the same had proved futile;
That I am executing this affidavit to attest to the truth of the foregoing facts and to
request for a replacement of the said Social Security System Unified ID card from Social
Security System.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
__________ 2016 at Bacolod City, Philippines.
MARIKA JEAN N. JALANDO-ON
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2016 by the Affiant whom I have identified
through competent evidence of identity: PHILHEALTH ID No. 12-050610225-7.
Doc. No._____
Page No._____
Book No._____
Series of 2016.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF DAMAGE TO VEHICLE
I, ALBERTO V. MOLABIN, of legal age, single and presently residing at 88-B
San Juan Street, Bacolod City, Negros Occidental, after been dully sworn to in
accordance with law, hereby depose and say;
1. That I am a duly licensed driver with Professional Driver's License No.
FO114004221 which is valid until 19 June 2019.
2. That on July 18, 2016, at around 11:30 AM, I was driving a motorcycle
vehicle, owned and registered to PD888 DISTRIBUTORS, INC. which is more
particularly describe as follows:
Make: Suzuki Smash Color: Red
Engine Number: Plate Number: 5672QS
3. That while I was travelling north to east at Along Lizares Ave. Fronting Lizares
Mansion Brgy. 40, Bacolod City, I accidentally hit another vehicle, Toyota
Vios, color grey with bearing plate number AIA8095.
4. That the said vehicle was registered under the name of BPI Rental
Corporation driven by RODNEY JULAG-AY y WINGPO of L29 B18 Phil St.,
Brgy. Estefania, Bacolod City.
5. That the arrival of PO2 Romeo P. Gatuz JR. , Traffic investigator of Police
Precinct 6/ BCPO about 11:35 AM to conduct ocular investigation regarding
the incident.
6. That I am executing this affidavit to attest to the truth of the foregoing facts.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
__________ 2016 at Bacolod City, Philippines.
ALBERTO V. MOLABIN
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2016 by the Affiant whom I have identified
through competent evidence of identity: LTO Driver’s License No.
FO114004221.
Doc. No._____
Page No._____
Book No._____
Series of 2016.
REPUBLIC OF THE PHILIPPINES )
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, JOSEL M. MAGBANUA, of legal age, Filipino and a resident of Blk.4 Lot 39,
Punta Bato, Prk. Ramylo Village, Brgy. Tangub, Bacolod City, Philippines, after being
duly sworn to in accordance with law do hereby depose and say:
1. That I am the Logistics Head of PD888 Distributors, Inc., with office address
at Carlos Hilado Highway, Barangay Bata, Bacolod City since May 23, 2016
up to September 19, 2016;
2. That as a Logistic Head, I am tasked to utilized and control overall orders
from Booking Salesman to deliver from designated accounts, check and verify
individual documents valid for deliveries, and documentations of receipts and
other documents for deliveries gathered from the accounts.
3. That on May 25, 2016, the original copy of Purchase Oder receipt from the
account Ogassir Corporation-SLY with reference number No. 135562 dated
May 25, 2016 with the total amount of P2,038.00 from the receipt, were found
to be missing;
4. That despite diligent search and efforts to locate the said receipt, I could not
find the same that I now believe that it is lost beyond recovery;
5. That said Purchase Order receipt for countering collection have not been
collected from Ogassir Corporation-SLY;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and to support my claims from Ogassir Corporation-SLY, in lieu of
the ones that were lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
__________ 2016 at Bacolod City, Philippines.
JOSEL M. MAGBANUA
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2016 by the Affiant whom I have identified
through competent evidence of identity: Unified Social Security System No.
07-2752965-7.
Doc. No._____
Page No._____
Book No._____
Series of 2016.
REPUBLIC OF THE PHILIPPINES )
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, BERNIE B. FLORES, of legal age, Filipino and a resident of Blk.70 Lot 10,
Fortune Towne, Brgy. Estefania, Bacolod City, Philippines, after being duly sworn to in
accordance with law do hereby depose and say:
1. That I am one the designated Driver of Logistics Department of PD888
Distributors, Inc., with office address at Carlos Hilado Highway, Barangay
Bata, Bacolod City since April 21, 2015 up to the present ;
2. That as a Logistic Driver, I am tasked to utilized and control overall orders
from Booking Salesman to deliver from designated accounts, check and verify
individual documents valid for deliveries, and documentations of receipts and
other documents for deliveries gathered from the accounts.
3. That on February 13, 2017, the original copy of Purchase Oder receipt from
the account Farmacia Caro with reference number No. 147446 dated
February 13, 2017 with the total amount of P7,397.00 from the receipt, were
found to be missing;
4. That despite diligent search and efforts to locate the said receipt, I could not
find the same that I now believe that it is lost beyond recovery;
5. That said Purchase Order receipt for delivery and the total physical stocks
worth P7,397.00 have not been deliver from Farmacia Caro;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing facts and to support my claims from Farmacia Caro, in lieu of the
ones that were lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
__________ 2017 at Bacolod City, Philippines.
BERNIE B. FLORES
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2017 by the Affiant whom I have identified
through competent evidence of identity: Social Security System No. 07-
2628965-5.
Doc. No._____
Page No._____
Book No._____
Series of 2017.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, FOLGIE A. SALVE, of legal age, married and presently residing at Panesa St.,
Purok Kahirup, Brgy. Mansilingan, Bacolod City, Negros Occidental, That I am the Book
Ahead Personnel of PD888 Distributors Inc., under Megasoft Hygienic Products with
office address at Carlos Hilado Highway, Brgy. Bata, Bacolod City.after been dully
sworn to in accordance with law, hereby depose and say;
That I am a holder of a company ID card bearing serial number 88800185 issued
by PD888 Distributors, Inc.
That I used to wear the said Identification Card as per company policy
requirements and also for security purposes while on the field of duty;
That sometime on March 1, 2017, that when I arrive at the Main Office of PD888
Dist. In., located at Carlos Hilado Highway, Brgy. Bata, Bacolod City from my
designated area of field work activity and riding with my motorcycle, I discovered that
the company ID card with the safety clip for the cord was no longer attached on the ID
cord where I used to wear it;
That I might have inadvertently hit or pulled the ID cord along with the
identification card while on duty at field that never noticed;
That diligent effort to locate the same had proved futile;
That I am executing this affidavit to attest to the truth of the foregoing facts and to
request for a replacement of the said company ID card from PD888 Distributors, Inc.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
__________ 2017 at Bacolod City, Philippines.
FOLGIE A. SALVE
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2017 by the Affiant whom I have identified
through competent evidence of identity: BUREAU OF INTERNAL REVENUE
TIN No. 938249814.
Doc. No._____
Page No._____
Book No._____
Series of 2017.
REPUBLIC OF THE PHILIPPINES)
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, LORIE ANN J. MIRA, of legal age, married and presently residing at Lot#16,
Blk. 37, East Homes 5, Brgy. Mansilingan, Bacolod City, Negros Occidental, that I am
the Cashier of PD888 Distributors Inc., with office address at Carlos Hilado Highway,
Brgy. Bata, Bacolod City.after been dully sworn to in accordance with law, hereby
depose and say;
That I am a holder of a Unified Social Security System ID card bearing number
07-2250782 - 3 issued by Social Security System Office.
That I used to put the said Identification Card in my wallet, among others;
That sometime on March 12, 2017, when I arrived home from going other places
to spend a weekend, I discovered that the said Identification Card was no longer in my
wallet where I used to placed it and I didn’t even remember if I retrieve it from one of the
store I visit that day for official information regarding purchases I made and I already
asked and checked every store to verify and to locate the said ID;
That I might have inadvertently dropped the said Unified Social Security System
ID during continuous transactions from other stores that day;
That diligent effort to locate the same had proved futile;
That I am executing this affidavit to attest to the truth of the foregoing facts and to
request for a replacement of the said Unified Social Security System ID card from Social
Security System Office.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of
__________ 2017 at Bacolod City, Philippines.
LORY ANN J. MIRA
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2017 by the Affiant whom I have identified
through competent evidence of identity: BUREAU OF INTERNAL REVENUE
TIN No. 942542915.
Doc. No._____
Page No._____
Book No._____
Series of 2017.
REPUBLIC OF THE PHILIPPINES )
CITY OF BACOLOD ) S.S
X----------------------------------------------X
AFFIDAVIT OF LOSS
I, JOSE EDUARDO A. VILLANUEVA, of legal age, Filipino and a resident of Prk.
Ramylo Village, Brgy. Tangub, Bacolod City, Philippines, after being duly sworn to in
accordance with law do hereby depose and say:
1. That I am the Book Ahead Salesman of PD888 Distributors, Inc., under Megasoft
Division with office address at Carlos Hilado Highway, Barangay Bata, Bacolod City
since October 7, 2015 up to the present;
2. That as a Book Ahead Salesman, I am tasked to obtain bookings/sales orders from
various customers in the sales rout areas with in Bacolod City, collect cash and
check payments from customers in the course of assigned sales rout and issue sales
invoices, submit booking/sales order to PD 888’s main biller in the PD 888 main
office and submit daily collection reports detailing each sales transactions,
turnover/remit sales cash and check collections to the PD 888 main office supported
by daily collection reports and corresponding sales invoices, and documentations of
receipts and other documents for deliveries gathered from the accounts.
3. That on May 25, 2016, the original copy of Purchase Oder receipt from the account
Lopue’s San Sebastian with reference number No. 86236 dated July 7, 2017 with
the total amount of P24,148.80 from the receipt, were found to be missing;
4. That despite diligent search and efforts to locate the said receipt, I could not find the
same that I now believe that it is lost beyond recovery;
5. That said Purchase Order receipt for countering collection have not been collected
from Lopue’s San Sebastian;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my claims from Lopue’s San Sebastian, in lieu of the ones that were
lost.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
__________ 2017 at Bacolod City, Philippines.
JOSE EDUARDO A. VILLANUEVA
AFFIANT
SUBSCRIBED AND SWORN to before me, a notary public for the City of
Bacolod this ______ day of ________ 2017 by the Affiant whom I have identified
through competent evidence of identity: Unified Social Security System No. 07-
2334040-3.
Doc. No._____
Page No._____
Book No._____
Series of 2017.
