REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF BATANGAS )S.S.

AFFIDAVIT

I, EMEELIZA H. CAPONPON, of legal age, Filipino, single and a resident of

Sto. Niño, Taysan Batangas, after having been duly sworn in according to law,
hereby depose and say:

That I am an employee of IBIDEN PHILIPPINES INCORPORATED with

principal place of business situated at FPIP, Sta. Anastacia, Sto. Tomas Batangas;

That as an employee, I was given the authorized Cellphone badge by my

employer which serves as a Gate Pass in bringing cellphone inside the production
premises;

That the said authorized cellphone badge was lost yesterday, March 3, 2015
within the company premises and after noticing the same, I exerted all my efforts to
locate my said authorized cellphone badge in all possible places where I believed it
could be found, however, despite meticulous searched, I was not able to locate my
said cellular phone and in my personal belief the same is now beyond recovery;

That I executed this affidavit to confirm the truth of all the facts herein stated
and to request the company to issue in my favor another and/or new authorized
cellphone badge in lieu of the lost and further, for such other legal intents and
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of March,
2015 at Batangas City.

EMEELIZA H. CAPONPON
Affiant
Unified Multi-Purpose ID CRN-0004-1858042-6

SUBSCRIBED AND SWORN to before me this 4th day of March, 2015 at

Batangas City.

Doc. No. 146 JOSELITO M. DIMAYACYAC

Page No. 30 Notary Public For & In The City of Batangas,
Book No. LXXXI Municipalities of Tingloy, Mabini, Bauan,
Series of 2015 San Pascual and San Jose
Until December 31, 2016
Rm. 3, Golden Luck Building,
Apacible Street, Batangas City
Roll No. 26881
PTR No. 2336317/Batangas City/ 1-5-2015
IBP No. 945061/Batangas City/1-5-2015
MCLE Compliance No. IV-0003338;11-8-2011
TIN: 114-010-980
Commission No. 2015-31

Aff-loss(cell_badge)