REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S

AFFIDAVIT OF LOSS

I, MICHELLE E. GALGANA, Filipino, of legal age, single and with residence at 427
Victorino St., Talipapa, Novaliches, Quezon City, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

1. That I am the plan holder of the ST.PETER LIFE PLAN INC. having been issued Life
Plan Contract Number N16657329D with certification;

2. That sometime last November 2022, I placed my documents inside my locker at my

office and when I recently looked for my copy of the said Policy Certification, I could
not locate the same;

3. That despite diligent search and effort to locate the above-mentioned Policy Certification,
I could not find the same such that I now believe that it is now lost beyond recovery;

4. I execute this affidavit to attest to the truth of the foregoing, to secure another copy of the
said certification, and for whatever legal purpose it may serve.

As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and for
whatever legal purposes that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________, in the

City of _____________, Philippines.
Michelle E. Galgana
Affiant

SUBSCRIBED AND SWORN to before me this __ day of ________________ 2023 in

__________________________. Affiant’s exhibited to me her LTO Driver’s License No. N02-
22-306293 as her valid proof of identification, valid until 12/11/2026.

NOTARY PUBLIC
Doc No. ;
Page No. ;
Book No. ;
Series of 2023