Republic of the Philippines)

La Trinidad, Benguet) s.s

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

AFFIDAVIT OF LOSS OF POLICY CONTRACT

I, John B. Buluguey, of legal age, married, Filipino citizen, and a resident of LC 101,
Rocky Side 2, Lubas, La Trinidad, Benguet, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state THAT:

1. I am a bonafide member of the Armed Forces and Police Mutual Benefit Association,
Incorporated (AFPMBAI) since 2008. As such, I was issued an AFPMBAI Policy
Contract.

2. I had been diligently and cautiously keeping said Policy Contract since the same was
issued to me inside my personal folder, along with some other personal papers, until it
got lost, as follows:

a. Sometime in October 2018, I received a letter from AFPMBAI informing me

that my policy will mature on December 2018. Thereafter, sometime on
December 2018, I started to look for my afore-quoted policy contract
purposely to claim the benefits therein pursuant to the AFPMBAI Letter in my
personal folders where I recall I last kept the same but unfortunately, I could
not locate said policy contract. I likewise searched inside the drawers in our
cabinet in our house but my efforts prove futile.

b. I have exerted extraordinary diligence to the search and recover said policy
contract but the same can no longer be found and I am now of the honest and
sincere belief that same is already lost and beyond recovery;

3. My afore-quoted AFPMBAI police contract has neither been used for any illegal
activities, nor confiscated by any government authorities for the enforcement of law,
rules and regulation, nor delivered to any person or entity in the performance of civil
obligation but due solely to the afore-cited reason;

4. I am executing this Affidavit to support my application with the AFPMBAI to claim

my benefits due to me. That, I hereby bind myself to fully excuse AFPMBAI for any
damage or injury that may be caused or incurred arising from this Affidavit.

5. Finally, 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 29 th day of December 2018
at La Trinidad, Benguet, Philippines.

JOHN B. BULUGUEY
Affiant
BJMP Badge No. 040052; Valid until Dec. 31, 2020

SUBSCRIBED AND SWORN TO before me, a Notary Public for and in La Trinidad,
Benguet, Philippines, this 29th day of December 2018, by the above Affiant, known to me of his
identity by competent evidence to be the same person who personally signed before me the
foregoing Affidavit.

ATTY. CYRUS C. CALAYA

Notary Public for Benguet Province
S & B Bldg., FA 224, Km. 4, National Highway, La Trinidad, Benguet
PTR. No. BGTCF 5221777, Feb. 7, 2018
Roll No. 52590; May 12, 2006; Manila City
IBP Lifetime No. 08051; Issued at Pasig City

Doc. No. 147; Page No. 30; Book No. V; Series of 2018