Republic of the Philippines)

) S.s.
x ----------------------------------------- x

AFFIDAVIT OF LOSS

I, CYNTHIA A. MEIMBAM of legal age, Filipino, with office address at Unit

1203 of Medical Plaza Ortigas, San Miguel Avenue, Ortigas Center, Pasig City,
do hereby depose and state that:

1. When I purchased Unit 1203 of Medical Plaza Ortigas, San

Miguel Avenue, Ortigas Center, Pasig City I the amount Two
Million Two Hundred Thirty Five Thousand Pesos (₱ 2,235,100.00) I
issued the corresponding receipt/s of the payment;

2. I keep said Receipts in the cabinet in our house with some other
important documents;

3. When I ask to produce the same, and tried to retrieve the said
receipts from the cabinet at home, the receipts were missing
and could no longer be located

4. Diligent efforts exerted to locate the missing Receipt proved futile;

5. I execute this Affidavit of Loss to inform all authorities

concerned of the facts surrounding the loss of this Receipt and
for whatever legal purpose it may serve.

IN WITNESS HEREOF, I have signed this instrument this 23th day of July
2019 in Quezon City.

CYNTHIA A. MEIMBAM
Affiant/ Buyer

SUBSCRIBED AND SWORN to before me this _____________________

in____________________. Affiant exhibited to me her BIR, TIN 104-119-240

Doc. No. ____;

Page No. ___;
Book No. ____;
Series of 2019.