AFFIDAVIT OF LOSS

That I, JESSA D. PLOJO , of legal age, Filipino citizen, single, and a resident of
Brgy Veteran's Village, Ipil, Zamboanga Sibugay, under oath in accordance with law,
hereby depose and state THAT:

1. The undersigned affiant was issued a Non-Professional Driver's License bearing

License ID No. XXXXXXXX, issued by LTO Ipil;

2. Due to some family concerns, she decided not to continue the purchase and
withdraw the car reservation fee described at paragraph 1 hereof;

3. Recently, she discovered that the car reservation fee receipt mentioned in
paragraph 1 hereof is missing and can no longer be found despite diligent efforts to locate
the same;

4. The fact of loss of the said car reservation receipt is attributed to the lack of
safekeeping facility of the undersigned affiant and at the same time due to the
unprecedented weakening of memory of the undersigned affiant brought by her age;

5. I am voluntarily executing this Affidavit to attest to the fact of loss of my car

reservation receipt with OR No. G1005553 dated July 7, 2014 and to inform Toyota
Isabela about such fact of lost and other legal services it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 21st day of

December 2019, at Ipil, Zamboanga Sibugay.

JESSA D. PLOJO
Affiant
Senior Citizen ID No. 14702

SUBSCRIBED AND SWORN to before me this ___ day of September, 2015 at

__________, Isabela. Affiant has exhibited to me her Senior Citizen ID appearing below
her picture and signature which is a competent proof of her identity.

Doc. No. _____;

Page No._____;
Book No.____ ;
Series of 2015.