REPUBLIC OF THE PHILLIPPINES)

City of Bacolod City, Negros Occ.) S.S.

x--------------------------------------------x

AFFIDAVIT OF LOSS

I, ___________, of legal age, single, Filipino, and a resident of Hervias

Village Bacolod City, after being duly sworn to in accordance with law, do hereby
depose and say:

That I am the Corporate Secretary of _____________________________, a

domestic corporation duly registered and existing under the laws of the Republic of
the Philippines, with Head Office address at BM Building, San Juan Street, Bacolod
City;

That the above-named company is conducting business in the Philippines

and is duly registered as a taxpayer with the Bureau of Internal Revenue (BIR),
Revenue District Office No. 077, based in Bacolod City, Neg. Occ.;

That the Company’s books of accounts were lost and could not be found
notwithstanding diligent efforts exerted to locate the same;

That this affidavit is executed to attest to the truth of the foregoing and for
other legal purposes it may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____ day of ______________, 2016, at Bacolod City, Philippines.

_______________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of __________,

2019 at Bacolod City, Philippines. Affiant exhibited to me his Tax Identification
Number ________.

NOTARY PUBLIC

Doc. No._______;
Page No._______;
Book No._______;
Series of 2019.