REPUBLIC OF THE PHILIPPINES )

______________________ ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, _________________, of legal age, Filipino, after being duly sworn, hereby depose
and state that:

1. I am the duly appointed _______________ of ____________________ (the

“Corporation”), a corporation with address at ______________________;

2. As _______________ of the Corporation, I keep in my custody the following official

receipts from The Manila Electric Company for the differential bill deposit of the
Corporation under the name of Filinvest Alabang, Inc. (the “Receipts”):

Date of Receipt Amount Paid

3. I have recently discovered that the Receipts are irretrievably lost and can no longer be
found despite diligent efforts to locate the same;

4. I execute this affidavit to attest to the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ________________ at

__________________.

_____________
Affiant

SUBSCRIBED AND SWORN to before me this __________________ at

__________________, affiant exhibiting to me his _____________ as proof of his identity.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2017.