Republic 

of the Philippines)
Province of Cebu )S.S.
Mandaue City )
x---------------x

AFFIDAVIT OF LOSS

I, GWEN R. VARGA, Filipino, of legal age, married and a resident of A. Pedroza

St., Bogo City, Cebu, Philippines, after being duly sworn in accordance with law,
depose and state:

1. That I am a Plan Holder of PHILPLANS and I was issued a Plan Contract under
Plan Number 3004320751 ;
2. That the said Plan Contract while in my possession was misplaced and got lost;

3. Efforts were exerted to locate the said Plan Contract however, it could not be
found and the same is now beyond recovery;

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

foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

Mandaue City, Cebu, Philippines.

GWEN R. VARGA
Affiant

SUBSCRIBED AND SWORN TO before me ______________ in Mandaue City,

Cebu, Philippines, affiant being personally known to me to be the same person who
executed the foregoing instrument.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.