Republic of the Philippines )

Province of Southern Leyte ) s.s.

Municipality of Tomas Oppus )
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AFFIDAVIT OF LOSS

I, MYRA T. VECINA, of legal age, married, Filipino and a resident of Brgy.

Punong, Tomas Oppus, Southern Leyte, after having been duly sworn to an oath
in accordance with law, hereby depose and say:

1. That I am an insured member of St. Peter Life Plan, Inc, and as such, I was
issued a Certificate of Full Payment;

2. That the said Certificate was kept in my drawer for personal belongings.
However, sometime on May 2013 typhoon Yolanda hit our province
damaging all my personal belongings including the said certificate;

3. That exhaustive efforts were exerted to locate the same but my search
proved futile as I could not locate the same up to present;

4. That I executed this affidavit in order to attest to the truth and veracity of
the foregoing and for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of March
2019 in the Municipality of Tomas Oppus, Southern Leyte, Philippines.

____________________
MYRA T. VECINA
Affiant
Passport No. P3867610A

SUBSCRIBED AND SWORN to before me this 22nd day of March 2019 in the
Municipality of Tomas Oppus, Southern Leyte, Philippines.