REPUBLIC OF THE PHILIPPINES )

______ CITY ) S. S.

AFFIDAVIT OF NON-RECEIPT AND UNDERTAKING

I, _______________ , of legal age, Filipino, and a resident of

_______________
_______________________ after having been duly sworn according to law, hereby
depose and state :

1. That I am a registered stockholder of Aboitiz Equity Ventures, Inc.

(AEV) with a total stockholdings of ______ shares to date;

That I have not received the stock dividend certificate issued in ____
totalling _____ shares:

CERT. NO. NO. OF SHARES REGISTERED

NAME
_____ ____ ________________

2. That inquiries and verifications made proved futile and fruitless and I
therefore consider the above-mentioned AEV stock certificate already
lost beyond recovery for all legal intents and purposes;

3. That I hereby declare and attest that said certificate was not sold,
transferred, pledged or in any manner encumbered by me to secure
the payment of any obligation on my part, or any other purpose;

4. That I hereby request THE HONGKONG AND SHANGHAI BANKING

CORPORATION LIMITED (HSBC) as Transfer Agent of Aboitiz Equity
Ventures, Inc. to issue the replacement certificate in lieu of the lost
certificate;

5. That in consideration for granting said request, I hereby bind and

obligate myself to hold Aboitiz Equity Ventures, Inc. and THE
HONGKONG AND SHANGHAI BANKING CORPORATION LIMITED (HSBC) their
officers, management, stockholders and agents free and harmless
from any liability to claim by any third person or entity whomsoever,
arising out of or in connection with the issuance by them of a
replacement certificate in lieu of the one which is lost.

IN WITNESS WHEREOF, I hereunto set my hand this ___th day of

_________, 2015 at ______ City, ______.
 __________________
AFFIANT

SUBSCRIBED AND SWORN to before me this _____ day of

_______________
at _____, ______, affiants exhibiting to me his/her competent evidence of
identity:

Gov’t Issued ID Issued on

Place

Name

NOTARY PUBLIC

Doc. No. _____________

Page No. _____________
Book No._____________
Series of 2018.