REPUBLIC OF THE PHILIPPINES}

X-------------------------------------------X

AFFIDAVIT OF LOSS

I, JUSTIN ALAIN PHILIPPE A. BERNAS of legal age, Filipino, Single and resident of
177 Imadejas Subdivision, Butuan City after having been duly sworn to in accordance to law,
hereby depose and say:

1. That I am the same JUSTIN ALAIN PHILIPPE A. BERNAS, Son of the late
WINSTON T. BERNAS., the beneficiary of Life Plan Application of my father with
Contract No. L17183621B duly issued by St. Peter Life Plan Butuan East Branch, Butuan
City, Agusan del Norte;

2. That the LIFE PLAN APPLICATION with contract no. L17183621B was
misplaced and ultimately was lost;

3. That I have exerted effort to locate but despite said efforts, all were in vain;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever purpose it may serve under the law;

AFFIANT FURTHER SAYETH NONE

_____________________________, PHILIPPINES.

JUSTIN ALAIN PHILIPPE A. BERNAS

Affiant

SUBCRIBE AND SWORN to before me this ____ day of _______________

______ After having exhibited his/her CTC No. _______________on ____________
at __________________.

Page no. __________

Doc. no. __________
Book no. __________
Series of 2022