REPUBLIC OF THE PHILIPPINES)

C I T Y O F M A K A T I ) S.S.

AFFIDAVIT OF LOSS

I, MA. EDITHA D. VICTORIA, of legal age, Filipino citizen, with residence address at
#378 Geronimo Street, Barangay 172, Malibay, Pasay City, after having duly sworn to in
accordance with the law do hereby depose and state, that:

I am a holder and possessor of the following items:

I am executing this affidavit to attest to the truth of foregoing facts, for information
and guidance of proper authorities concern and for whatever legal purpose this affidavit
may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto set my hand on this 30 th day of April 2022, in the
City of Makati.

MA. EDITHA D. VICTORIA

Affiant

SUBSCRIBED AND SWORN to before me on this 30th day of April 2022, in the City of
Makati.

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SERIES OF: 2022.