EPUBLIC OF THE PHILIPPINES)

City of ) S.S.
x-----------------------x

AFFIDAVIT OF LOSS
I, Carmelita Clemente Santiago, Filipino, of legal age, married, and with
business address at Turo, Bocaue, Bulacan, Philippines, after being duly sworn in
accordance with law, depose and state:

1. That I am the business owner for LEOCAR APARTMENT with BIR

TIN 164-319-071-000 and existing under and by virtue of the laws
of the Republic of the Philippines;

2. That sometime in November 2020, during the typhoon Ulysess, the

original booklet of my Official Receipt with the Authority to Print
and other pertinent documents was lost in flood and could not be
found and that despite of diligent search and efforts, the same could
no longer be found such that I now believe that it is now lost beyond
recovery.

3. As such, I am executing this Affidavit of Loss to attest to the truth of

the foregoing and for whatever legal purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______day of _____

2021 at ______________, Philippines.

Carmelita C. Santiago
AFFIANT

SUBSCRIBED AND SWORN to before me, this ____ day of _____ by the Affiant who
whom I have identified through competent evidence of identity and who exhibited her
_______________________ issued at _____________ on ____________.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2021.