REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS

I, CARMELA I. ABORDO, of legal age, Filipino, married to ALLAN

ABORDO and a resident of Bacoor City, Cavite, after having been duly sworn to
in accordance with law, depose and state THAT:

1. I entered into a Contract for a Life Plan with St. Peter Life Plan sometime
2010 with the following details:

Planholder: Carmela I. Abordo

Contract No.: N10284763 SA1: Abacero, Yolanda
DIPOLO-10-0009019 Due Date: 28th/M
Effectivity: 31 October 2010 Inst. Amt.: 650.00
Plan Type: St. Francis Branch: Dipolog

2. Sometime on September 2014, when I was going through my personal

papers in our residence in Dipolog, I realized that said Contract with St.
Peter Life Plan was missing;

3. I exerted all efforts to locate said said contract, but in spite of diligent
search, I was not able to find it and the same is now beyond recovery;

4. 5. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to request for a certified true copy of the contract from St.
Peter Life Plan and request for the reinstatement of my life plan;

IN WITNESS WHEREOF, I have hereunto set my hand this 5 December

2015 in ________________, Philippines.

CARMELA I. ABORDO
Affiant
Govt ID No. _____________

SUBCRIBED AND SWORN TO before me this __________________ in ______________, Philippines,

affiant exhibiting to me his/her competent evidence of identity by way of ID No. __________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2015.