Affidavit of Loss

KNOW ALL MEN BY THESE PRESENTS:

I, ____________, of legal age, Filipino, married, and a resident of _______________________, after

having been sworn in accordance with law hereby state that:

1. I am the Treasurer of __________________________, a corporation existing under the laws of

the Philippines, with principal office located in _________________;

2. The following invoices were issued to _____________________, which were sent by post office
mail:

The original of said invoices, though sent by mail, were apparently not received by your good
company. Copies of said receipts are attached as Annex A.

3. Despite follow-ups and inquiries with the Post Office, the mail containing the original of the
subject invoices could no longer be found, and should therefore be considered lost for all intent
and purposes;

4. This affidavit is being executed to attest to the foregoing, and as a certification to the authenticity
of the copy hereto attached.

5. Affiant further sayeth naught.

In witness whereof, I have hereunto signed this ___ day of _______________ in ______ City,
Philippines.

Affiant

Subscribed and sworn to me this __ day of ___________, affiant showing to me her

______________________.

Doc. No.
Page No.
Book No.
Series of 2018