Republic of the Philippines)

In the City of Baguio.) S.S.

AFFIDAVIT
I, FELIX P. QUINAGORAN, of legal age, married, Filipino citizen, with
residence and postal address at No. 106 Brgy. Alapang, Sitio Camp Dangwa,
La Trinidad, Benguet, Philippines, after having been duly sworn to in
accordance with law hereby depose and state:
1 That I am a retired Police Officer and member of the Mutual Benefit
Association Incorporation (AFPMBAI) and was issued an AFPMBAI
BASIC POLICY CONTRACT;
2 That the said AFPMBAI Basic Policy Contract was lost/missing since
June 15, 2012 it might misplace in our house. I exerted diligent
effort to locate the said document but the same could no longer be
found; hence, considered forever lost;
3 That said AFPMBAI Basic Policy Contract was never given nor
pledged to anyone for any purpose whatsoever, nor was it taken or
confiscated by the authorities for any violation of the law;
4 That I am executing this affidavit to attest to the veracity and
truthfulness of my foregoing statements and for other lawful intents
and purposes it may serve.
IN WITNESS HEREOF, I have hereunto affixed my signature this 26 th
day of September, 2012 at Baguio City, Philippines.

FELIX P. QUINAGORAN
Affiant
SUBSCRIBED AND SWORN to before me this 26th day of September,
2012 at Baguio City, Philippines. Affiant personally appeared before and
identified by me through his PNP Identification Card and the same person
who executed this affidavit freely and willingly.
Doc. No. 403;
Page No. 82;
Book No. 3;
Series of 2012.