REPUBLIC OF THE PHILIPPINES

)
CITY OF MALAYBALAY
) S.S
AFFIDAVIT OF LOSS
I, JESUS R. GARGAR, of legal age, Filipino and a resident of Casisang,
Malaybalay City, Bukidnon, after being sworn to and in accordance with law,
do hereby depose and state:
1. That, I am the Chief Compliance Officer of D Asian Hills Bank, Inc. (A
Rural Bank) with principal office address at 2F DAHBI Center, Fortich
Street, Malaybalay City, Bukidnon;
2. That, the D Asian Hills Bank, Inc. (A Rural Bank) has acquired preferred
shares at the Land Bank of the Philippines in reference with Stock
Certificate Nos.___________________ issued on ______________________;
3. That, the same stock certificates were lost sometime on or before
December 2012 inside the premises of D Asian Hills Bank, Inc.
Malaybalay Branch, prior to my appointment as a Chief Compliance
Officer;
4. That, upon knowledge that they were lost, I immediately exerted
efforts to locate the same but all efforts prove futile;
5. That, I am executing this affidavit in order to attest to the truth of the
foregoing circumstances and for the purpose of reporting the loss of
the said Stock Certificates for replacement thereof and for other legal
purposes.
IN WITNESS WHEREOF, I have hereunto set my signature this
____________________, in Malaybalay City, Bukidnon, Philippines.

JESUS R. GARGAR
Affiant

SUBSCRIBED AND SWORN to before me this ____________________,

affiant exhibiting to me his valid identification card as sufficient proof of his
identity, known to me as the same person who executed the foregoing
instrument. I hereby certify that I have examined the affiant and I am
satisfied that he understood the contents of his affidavit and has voluntarily
executed the same in his own free will.

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Series of 2015