Affidavit of Loss

Republic of the Philippines)

City of Taguig ) S.S.

AFFIDAVIT OF LOSS

I, { }, Filipino, married, of legal age, with address at { }, Philippines subscribing under oath, hereby depose:

1. { } was in the possession of the following Statement of Accounts issued gadgets:

1. Phone { } with reference no. { } under { } with the amount of { };

2. Phone { } with reference no. { } under v with the amount of { };

3. Phone { } under { } with the amount of { };

4. Phone { } under { } with reference no. { } with the amount of { };

5. Phone { } under { } with reference no. { } with the amount of { } and;

6. Phone { } under { } with reference no. { } with the amount of { }.

2. Sometime in { }, I noticed that the aforementioned series of statement of account were already missing.

3. The said series of statement of account were lost when we transfer to our new office in { }.

4. Despite due diligent search the aforementioned Statement of Account cannot be located.

5. In view thereof, I am executing this Affidavit of Loss for whatever purpose it may serve.

6. Affiant further sayeth naught.

{ }

Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in Taguig City, personally appeared this { }, { }, who presented to me his { } No. { } , the same bearing affiant's photograph and signature, and who attested that he is the same person who personally signed before me the foregoing document and acknowledged that he executed the same.

{ }

Doc. No. { }

Page No. { }

Book No. { }

Series of { }