Republic of the Philippines

Province of ___________
City of _______________

AFFIDAVIT OF LOSS

I, ARRABEL QUEENIE C. VALENZUELA of legal age, Filipino,

residing at No. 33 5th West Crame, Brgy. West Crame, after being sworn in
accordance with law, depose and say:
That I am the true owner of the original copy of EMMRJ LOAN
CONSULTANCY CORPORATIO BIR Printed Official Receipt, described as
follows to wit:
That sometime by 2018 a fire incident happened in our house, on which area
I kept my personal belongings and pertinent documents/records, wherein due to
said fire some of my important docs. as I mentioned above was damaged and
seems lost due to appearance of burned by fire.
Finally I was looking for the said receipts because I need to show the said
receipts for some very important reasons, which time also I realized said Receipts
was missing,
That the said Receipt was acknowledged and issued by ELAINE JOY
SANTOS on April 28, 2018 for and in consideration of the amount of FIVE
HUNDRED THOUSAND PESOS Php 500,000.00 I paid in cash for securities I
purchased in total no. o 5 shares or equivalent to 5 percent from her company
EMMRJ;
That the said Receipt was issued given to me together with the issuance of
EMMRJ Stock Certificates showing the date of payment, my name and the no. of
securities I paid in cash from EMMRJ shares which signed by Ms Santos as Main
Owner and the issuance of the Notarized “Co-ownership Agreement” made and
executed between me and the company. That said issued receipt was in my legal
possession before an incident happens in the area where I keep my personal
belongings and important business documents. That the above stated documents
are the best proofs of my ownership of the loss Official Receipt for such reason of
issuance was same as accompanied documents for the securities I purchased since
that the pertinent copy of it cannot be recovered and found nowhere when my
house and all my personal belongings were completely destroyed by incident of
sudden fire;
That said “Official Receipt” are now beyond recovery.

IN WITNESS WHEREOF, I have hereunto set my hand this ________

day of ________, 20__, in the Municipality of ____________, Province of
__________, Philippines.

ARRABEL QUEENIE C. VALENZUELA

(Signature of affiant)\

NOTARY

Doc No. :_________

Page No.:_________

Book No.:________

Series of 2019