AFFIDAVIT OF LOSS

I, LEONIDA TANTUAN ALINSOB, Filipino, of legal age, and a resident of Franciscan Handmaids of
the Lord, Mount La Verna, Brgy. Libertad, Palo, Leyte, after having been duly sworn in accordance
with law, hereby depose and say:

1. That I am a plan holder of ETERNAL PLAN, INCORPORATED having been issued Policy
Contract Number L200310007981.

2. That I have also been issued a Certificate of Full Payment on October 23, 2003 pursuant to
that contract.

3. That the said Policy Contract and Certificate of Full Payment were lost during the typhoon
Yolanda and can no longer be found despite diligent efforts to locate the same.

4. That the said Policy Contract has not been pledged, nor encumbered in any way.

5. That I am executing this affidavit to attest the truth of the foregoing.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 7 th day of August, 2017 at
Maasin City, Southern Leyte, Philippines.

LEONIDA TANTUAN ALINSOB

Affiant
Postal Identity Card: PRN 132150237498 B
Issued at Palo, Leyte

SUBSCRIBED AND SWORN TO before me this 7 th day of August, 2017 at Maasin City, Southern
Leyte, Philippines.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2017