Republic of the Philippines)

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS OF OFFICIAL RECEIPT

I, Marie Fe Manggay Alumbro, of legal age, married, Filipino, and resident of FE
122, Km.3, La Trinidad, Benguet, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state THAT:

1. I purchased from Tiongsan Supermart Incorporated (Tiongsan) located at Km.

4, Pico, La Trinidad, Benguet a LP GAS Regulator described as GAS
AUTOSAFETY CONTROLLER sometime on November 30, 2020.
Accordingly, I was issued an Official Receipt (OR) for the said purchase by
Tiongsan. What I recall is that I got the receipt after I pay the necessary
amount and put inside my pocket.

2. Thereafter, I brought home the said LP Gas Regulator. After few weeks we
decided to use the said item, but to my surprised the said GAS Regulator has
two (2) Detachable Fitting, which I only need one (1) fitting. Therefore, I
decided to refer the matter to Tiongsan, the seller/dealer/distributor. I was
then required to present the Official Receipt thereof.

3. However, when I tried to locate the said OR in my bags and other belongings,
I was shocked that it was no longer inside the same. Immediately, I searched
the same within the premises and/or in other places where I might kept the
said receipt but I was still unable to locate it.

4. Despite diligent efforts exerted, I was not able to locate the afore-mentioned
OR until now. Therefore, I considered it lost and beyond recovery. The loss of
the same is not deliberate but purely due to mere inadvertence or excusable
neglect;

5. I am executing this affidavit to attest to the truthfulness of the foregoing facts

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

IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day December
2020, at La Trinidad, Benguet, Philippines.

Marie Fe Manggay Alumbro

Affiant
TIN ID No. 488-385-491-000

SUBSCRIBED AND SWORN to before me a Notary Public for and in La

Trinidad, Benguet, Philippines this December 2, 2020, by the above Affiant, who
exhibited to me her ID as competent evidence of identity with picture above her name
and identified by me to be the same person who personally signed before me the
foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Doc. No. ____; Notary Public until Dec. 31, 2021
Page No. ___; PTR No. BGTCF 6232438; Jan. 10, 2020
Book No. I; IBP Lifetime No. 08051, at Pasig City
Series of 2020. Roll No. 52590, May 12, 2006; Manila
S & B Bldg., FA 224, Km. 4
National, Highway La Trinidad, Benguet