Republic of the Philippines)

La Trinidad, Benguet) s.s

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AFFIDAVIT OF LOSS

I, Jim Beam M. Tolding, of legal age, married, Filipino citizen and a resident of IC-47,
Betag, La Trinidad, Benguet Province, Philippines, after having duly sworn to in accordance
with law, do hereby and depose and state THAT:

1. I am the lawful and declared owner and possessor of a certain parcel of land located
at Betag, La Trinidad, Benguet with an area of Six Hundred Ninety Eight (698)
Square meters covered by Assessment of Real Property (ARP) No. 2010-03-09-
00584 of the Tax Rolls of La Trinidad Assessor’s Office.

2. Since said property was transferred in my name, I have kept the original owner’s
copy of ARP No. 2010-03-09-00584 inside the drawer of our cabinet at our old
family house located at Betag, La Trinidad, Benguet. Sometime in 2010, after our
new house was constructed, we decided to transfer thereat. Consequently, we have to
move and transfer all our personal things, baggage’s and belongings including our
cabinet where I safely kept the said original copy of tax declaration;

3. Thereafter, we settled down at our new house. I was confident at that time that the
subject original copy the Tax Declaration was still intact with the said folder;

4. Unfortunately, lately when I search for it in the premises supposedly to be used as

security for a loan, I notice that the same is no longer inside the drawer. I then and
there immediately search for it in the premises, but I was not able to locate the same.

5. Despite diligent efforts exerted, the same proved futile. I therefore consider the said
owner’s original copy of ARP No. 2010-03-09-00584 irretrievably lost and beyond
recovery.

6. The said tax declaration was not cancelled nor delivered to any person or entity for
the satisfaction of any civil obligation. I am executing this Affidavit to attest to the
truth of the foregoing facts and for all legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th day of May 2017, at
La Trinidad, Benguet, Philippines.

JIM BEAM M. TOLDING

Affiant
TIN 190-831-224

SUBSCRIBED AND SWORN to before me a Notary Public for and in La Trinidad,

Benguet, Philippines this 11th of May 2017, by the above Affiant, personally known to me by
competent evidence of his identity to be the same person who personally signed before me the
foregoing Affidavit.