REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF HILONGOS) S.S.

PROVINCE OF LEYTE )

AFFIDAVIT OF OWNERSHIP

I, MARY ANN FLORES, Filipino citizen, of legal age, married, and a resident of Western
Poblacion, Hilongos, Leyte, after first being duly sworn to , depose and say:

1. That I am an absolute, exclusive and lawful owner and possessor of personal properties which
are herein below described as follows;

One (1) unit LA GERMANIA Gas Range

Model No. SL530 00W
Serial No. 0411-3139

One (1) unit PANASONIC Refrigerator

Model No. NR-A705ECTG
Serial No. 751609687

One (1) unit SAMSUNG Airconditioner

One (1) unit GE Airconditioner

2. That I acquired ownership and possession of the above-described properties by purchase but
the receipts and invoices evidencing the same have been misplaced;

3. That the above described properties are in good condition and free from all liens and
encumbrances whatsoever;

4. That I execute this affidavit to prove my lawful ownership and possession of the above-
described personal properties, for the purpose of making the same the collateral for my loan.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of March, 2013 at
Hilongos, Leyte, Philippines.

MARY ANN FLORES

Affiant

SUBSCRIBED AND SWORN to before me this 16th day of March, 2013 at Hilongos, Leyte,
Philippines, by affiant exhibiting to me Community Tax Certificate No. 11392263 issued on March 8,
2013 at Hilongos, Leyte.

EFREN B. MENDOZA
Doc. No. 157 Notary Public
Page No. 33 Until December 31, 2014
Book No. XXIII IBP No. 915453, Jan. 8, 2013, Tacloban City
Series of 2013 PTR No. PL 6190807, Jan. 29, 2013, Hilongos, Leyte
Roll No. 50005
TIN 906-925-044