Republic of the Philippines)

Calamba City, Laguna ) S.S

AFFIDAVIT OF LOSS

I, MARK JEREMIAS DELA TORRE REYES II, 34 years old, Filipino, married, and
with residence at Barangay Nanguma, Mabitac, Laguna, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

1. That I am a Sales Agent of PMFTC Inc and issued a receipt with Invoice Number
0694306-4600008078 dated 17 September 2022 in the amount of P11,034.00 to
JACK-RENZ Store;

2. That the said receipt of the above-mentioned was lost and its whereabouts cannot
be ascertained despite due and diligent search made and undertaken such that I
now believe that the same is lost beyond recovery;

3. That each and every fact herein stated is true and I am willing to testify before
any court of justice to substantiate the truth of each and all the said facts; and

4. That I am executing this Affidavit to attest to the truth of the foregoing facts and
to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of April 2023 at
Calamba,Laguna Philippines.

MARK JEREMIAS DELA TORRE REYES II

Affiant

SUBSCRIBED AND SWORN to before me this 10th day of April 2023 at Calamba City,
Laguna, affiant exhibiting to me his Driver’s License with number D12-07-002907.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2023.