REPUBLIC OF THE PHILIPPINES  )

) SS.

AFFIDAVIT

I, ________________________, Filipino, of legal age, and with office address at

_____________________________, after having been duly sworn to in accordance with law, do
hereby depose and state, THAT:

1. I am the ___________________ of _________________________, a

Corporation duly organized and existing under and by virtue
of the laws of the Republic of the Philippines with principal
business address at __________________________;

2. Given the above-mentioned position, it is my responsibility to

receive and keep in my custody official receipts issued by
Manila Electric Company (MERALCO) in favor of our
Company;

3. recently, the Original Copy of CUSTOMER RECEIPT No.

with Account Name of . Service ID
Number: issued by MERALCO
for the security deposit amounting to Php could
not be found and that despite of diligent search and efforts,
the same could no longer be found such that I now believe
that it is now lost beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest to the

truth of the foregoing and for whatever legal purposes that
this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________________ in

______________________.

___________________________

Affiant

SUBSCRIBED AND SWORN to me this _________________ affiant exhibiting to me

her
____________________________issued by the _______________________________ issued on
______________________ and valid until _______________________, as competent evidence of
identity.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2020