REPUBLIC OF THE PHILIPPINES) City of Manila

) S.S.

AFFIDAVIT OF LOSS I, Elizabeth Wales, Filipino, of legal age, residing at 161 Road 54 corner Mangahan st. Onyx Paco, Manila, after having been sworn in accordance with law hereby depose and state: That I am the true and lawful owner of a certain motor vehicle which is more particularly described as follows: MAKE SERIES TYPE OF BODY YEAR MODEL : Toyota : Altis : Sedan- 4-Door : 2005 MOTOR NO. SERIAL/CHASSIS NO. PLATE NO. FILE NO. 00000048409 : 1ZZ-4497230 : ZZE122-9003892 : ZBS-947 : 1364-

That sometime in January of this year, I was looking for the original Certificate of Registration of my car but to my surprise, said Owners original Copy could not be found; That I took pains to look for said Certificate of Registration, but to no avail; That I am executing this affidavit to attest to the truth of the foregoing and to request from the Land Transportation Office of the City of Manila, a copy of said Certificate of Registration. IN WITNESS WHEREOF, I have hereunto set my hand this 10th day of February, 2011 at Manila, Philippines.

Elizabeth Wales Affiant SUBSCRIBED AND SWORN to before me, this 11th day of February, 2011 in the City of Manila, with affiant exhibiting his CTC No. _______________ , Issued on ______________________ at _________________________. NOT ARY PUBLIC Until December 31, 2011 Doc. No. : ________; Page No. : ________; Book No. : ________; Series of 20___.