REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S. S.

AFFIDAVIT OF LOSS

I, Pia Margarita C. Sebastian, of legal age, Filipino, and with office address at PSBank Center, 777
Paseo de Roxas cor Sedeno St. Makati City, authorized representative of PS Bank, after having been duly
sworn to in accordance with law, hereby depose and state:

1. That I am the holder of the original Certificate Authorizing Registration (CAR) which
was issued to us by Bureau of Internal Revenue Parañaque last May 14, 2019,
specifically with the following details:

eCAR No.: C-2019-052-047084-M

Name of Seller: Ma Josephine Nasir and Saeed Nasir
Name of Buyer: Philippine Savings Bank
Title No.: 010 – 2016004462
Location of Property: Azure Urban Resort, Paranaque City
Issued date: May 2, 2019

Together with other documents including Original BIR Payments (DST and CGT),
Notarized Affidavit of Consolidation with BIR Stamp;

2. That unfortunately, the said account was discovered lost and / or misplaced last May
20, 2019;

3. That despite diligent search and efforts to locate / retrieve executed efforts proved
futile;

4. That such I have no other recourse but to declare the same as permanently lost;

5. That I am executing this Affidavit of Loss to attest to the foregoing facts and for
whatever legal intents and purposes it may deem serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________ day of ___________ 2019 at
the City of Manila.

_____________________________
PIA MARGARITA C. SEBASTIAN

SUBSCRIBED AND SWORN to before me this _________ day of ___________ 2019 at the City of
Manila

Doc No. _______

Page No. _______
Book No. _______
Series of 2019
REPUBLIC OF THE PHILIPPINES)
CITY OF MANILA ) S. S.

AFFIDAVIT OF LOSS

I, PEARL MITZI JOYCZ B. CRUZ, of legal age, Filipino, and with postal and residential
address at 289 ROMANA ST. VELASQUEZ TONDO, MANILA after having been duly sworn to in
accordance with law, hereby depose and state:

1. That I am the holder of the CLAIM STUB FOR DIPLOMA; which was issued
by the Pamantasan ng Lungsod ng Maynila

2. That unfortunately, the said document was discovered lost and / or

misplaced last February 2019;

3. That despite diligent search and efforts to locate / retrieve executed

efforts proved futile;

4. That such I have no other recourse but to declare the same as permanently
lost;

5. That I am executing this Affidavit of Loss to attest to the foregoing facts

and for whatever legal intents and purposes it may deem serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________ day of ___________
2018 at the City of Manila.

__________________________
AFFIANT

SUBSCRIBED AND SWORN to before me this _________ day of ___________ 2019 at the
City of Manila.

Doc No. _______

Page No. _______
Book No. _______
Series of 2019