AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA ) – s.s.

I, _______________________________--, of legal age, single, Filipino and

residing at ______________________, after being sworn duly in accordance
with law, depose and say:

1. That I am employed with the ________________, with business address at

________________.

2. On _____________________, we have submitted all the documentations for

the registration of stock corporation with the Securities and Exchange
Commission of the corporation named, ____________________ (the
“Company”), including the extended name reservation slip, with
Reference Reservation Number (RRN) _______________________, which
has been reserved under my name and extended for the period of
___________________________;

3. That on ___________________, the extended name reservation slip is now

considered lost and irretrievable;

4. I lost no time in diligently trying to locate said name reservation slip

issued by the SEC in the Company’s favor, but all efforts exerted
proved futile and to no avail, and that the same is considered to be lost
and beyond recovery;

5. That I am executing this affidavit to facilitate the replacement or

enable me to obtain a new SEC name reservation slip and other related
purposes such replacement may require.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd of April

2015, in the City of Manila, Philippines.

____________________________
______
Affiant

SUBSCRIBED AND SWORN to before me this ___th day of April

2015 at the City of Manila, affiant personally known to me and exhibiting to me
his ________________________.

IN WITNESS WHEREOF, I have set my hand and seal on the day, year and
place first written.

Doc. No.
Page No.:
Book No.
Series of 2019.