REPUBLIC OF THE PHILIPPINES)

City of Zamboanga) S.S.

x - - - - - - - -- - - - - x

AFFIDAVIT OF LOSS

I, MA. CATHERINE R. ENRIQUEZ, Filipino, of legal age, single

and a resident of Boalan, Zamboanga City, Philippines, after being
duly sworn to in accordance with law, hereby depose and state:

1. That I am a bonafide member of the Bureau of Fire

Protection;

2. As such, I was also a member of the Armed Forces & Police

Mutual Benefit Association, Inc., (AFPMBAI) and issued with
a corresponding Policy;

3. That I inadvertently misplaced and loss said Policy for

about a year ago;

4. That despite diligent search and efforts to locate said

item, I could not find it such that I now believe that it
is now lost and beyond recovery;

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

the truth of the foregoing and to support my request for
the issuance of a new Policy from AFPMBAI in lieu of the
one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this

____________________ at Zamboanga City, Philippines.

MA. CATHERINE R. ENRIQUEZ

Affiant

SUBSCRIBED AND SWORN to before me, this _____________________,

by the Affiant whom I have identified through competent evidence of
identity and who exhibited her BFP ID with Number E7015 with an
expiry date on year 2021.

ATTY. RODELO D. LUYAO

NOTARY PUBLIC
Until December 31, 2019
Roll of Attorney No. 67183
IBP No. 058521; 12/13/2018; Pasig City
PTR No. 1806778; 01/04/2019; Zamboanga City
MCLE Compliance No. VI-0003518; Valid Until April 14, 2022
Doc No. _____
Page No. ____
Book No. ____
Series of 2019