Republic of the Philippines )

Province of Leyte ) S.S.

Municipality of Carigara )

AFFIDAVIT OF LOSS TD CERTIFICATE

I, FILOMENO A. DALDE, of legal age, Filipino, married and a resident of

Poblacion Zone 1, Capoocan, Leyte, after being duly sworn to in accordance
with law, hereby depose and say:

1. That I have a Dollar Time Deposit Account with RCBC-Tacloban BC;

2. That as such, I was issued a Certificate of Time Deposit for the

Account No. 0000009003094107;

3. That I have lost said Time Deposit Certificate and have tried to
locate the same to no avail;

4. That I do hereby agree to hold Rizal Commercial Banking

Corporation harmless and to indemnify it for any loss that it may
sustain by reason of my request to transact on said Time Deposit
Placement.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of

______ 2018 at Carigara, Leyte, Philippines.

FILOMENO A. DALDE
Affiant
ID No.______________
Issued on:___________
Issued at:____________

SUBSCRIBED AND SWORN to before me this_____ day of _______, 2018

at Carigara, Leyte; affiant exhibiting to me his proof of identity as indicated
above.