REPUBLIC OF THE PHILIPPINES)

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

AFFIDAVIT OF LOSS

I, LEONARDITA MIRAFLOR FORIA, of legal age, Filipino citizen, with residence

address at 3279 Zapote Street corner Ponte Street, Sta. Cruz, Makati City, Philippines, after
having duly sworn to in accordance with law do hereby depose and state, that:

1. I am the lawful Grantee over the portion of graveyard, located at ETERNAL

GARDENS MEMORIAL PARK, Caloocan City which was purchased from ETERNAL
GARDENS MEMORIAL PARK CORPORATION, under Contract No. 0358 and
particularly described as follows:

LAWN: ETERNAL GRACE-R

SEC.: C
BLOCK: *33*
LOTS: *#14*

2. Further, I am a holder and possessor of the Pre-Need Purchase Agreement of the

aforesaid graveyard:

3. The discovery in the loss of the aforesaid document has been established, due to
circumstance beyond my knowledge; whereof, assuming that the same
misplaced and could no longer be found;

4. Diligent effort has been made but futile; therefore considered it lost for all
intents and purposes;

5. 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 our hands this 19 th day of August 2019, in the City of
Makati, Philippines.

LEONARDITA MIRAFLOR FORIA

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of August 2019, in the City of
Makati, Philippines.

DOC. NO.______
PAGE NO.______
BOOK NO.______
Series of 2019.