Republic of the Philippines…}

Province of Surigao del Sur…}

City of Tandag…} S. S.

AFFIDAVIT OF LOSS

I, CHARLES HECTOR G. ESTOSE, Filipino, of legal age and a resident of Bag-

ong Lungsod Tandag City, Surigao del Sur, state under oath, THAT:

1. I am a holder of a Cokaliong Shipping Lines Ticket for Surigao-Cebu dated

November 03,2018;

2. I kept said Cokaliong Shipping Lines Ticket in my wallet which contains also
other important documents;

3. However, the wallet which contains said Cokaliong Shipping Tickets and other
important documents was lost on November 01, 2018

4. I exerted all efforts to locate the same but to no avail;

5. I am executing this Affidavit to apprise Cokaliong Shipping Lines of the fact

of said loss for replacement and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 03rd day of

November 2018, in Tandag City, Surigao del Sur, Philippines.

CHARLES HECTOR G. ESTOSE

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and in the
Province of Surigao del Sur, this 03rd day of November 2018, in Tandag City, Surigao
del Sur, the affiant personally appeared and affixed his signature together with his
school ID as proof of his identity.