REPUBLIC OF THE PHILIPPINES }

MABALACAT PAMPANGA }

AFFIDAVIT OF LOSS

I, OWEN MACALINO, of legal age, Filipino, single and with office

address at City of San Fernando, Pampanga, after having been sworn to in
accordance with law, depose and say that:

1. That on May 6, 2011, I purchased from SM Appliance Center a Devant

LED TV model 26MEL100 with serial number K02110611 in which I was
issued an Official Receipt;

2. I kept the said official receipt at our office in Grandview Tower;

3. Sometime in October 2011, we moved our office from Grandview tower to

our Office in the City of San Fernando, Pampanga;

4. However, when we were moving some of the documents, we discovered

that some of the receipts including the official receipt issued by the SM
Appliance Center were missing;

5. We exerted earnest efforts but the same ended in futility;

6. As of this date, the official receipt issued by the SM Appliance Center for
the purchase of a Devant LED TV Model 26MEL100 is still missing and
can no longer be found;

7. That I am executing this Affidavit of Loss to attest the truthfulness of the

foregoing and for all legal purposes and intents it may serve.

In witness whereof, I hereby affix my signature on this 9 th day of January

2012 at Mabalacat, Pampanga.

OWEN MACALINO
Affiant

SUBSCRIBED AND SWORN to before me this 9 th day of January

2012 at Mabalacat, Pampanga, affiant exhibited to me his
___________________________ personally known to me to be the same
person who personally signed before me the foregoing and acknowledged
that she executed the same.

Doc. No. ________;

Page No.________;
Book No.________;
Series of 2012.