REPULIC OF THE PHILIPPINES

CITY OF MANILA

AFFIDAVIT OF LOSS

That I, sonny corp , of legal of age, Filipino Citezen and presently residing
at_____________________

That I am the lawful and bonifade of and in possession of ceretain

________________

That said above-mention ed was lost in our house due to my negligence

That despite diligent efforts exerted to locate and retieved, some proved futile hence
this affidavit, and do hereby request the honorable office concernede to issue in lieu of the
loss one ;

That I warrant, affirm and confirm that stipulation are true and correct as far as my
personal knowledge and behalf is concern;

That I am executing this affidavit to effect to the veracity of the contents hereof and
for all legal intents and purposes it may serve;

AFFIANT FURTHER SAYETH NAUGHT

AFFIANT

SUBCRIBED AND SWORN TO BEFORE ME, this _______day of 2018 in the city of
Manila, affiant exhibiting;

DOC NO.
PAGE NO.
BOOK NO.
SERIES
OF 2018