REPUBLIC OF THE PHILIPPINES CITY OF CEBU

) ) SS.

AFFIDAVIT OF LOSS
I, MA. APRIL MAE V. MENDOZA, Filipino, single, of legal age, wit !esi"en#e at $%&' East Capitol Site, Ce() Cit*, afte! a+ing (een ")l* swo!n in a##o!"an#e wit law, e!e(* "epose an" state t at, $. On No+e-(e! .&, .&$%, at a(o)t $&,&& a-, w ile I was p!o#essing -* loan "o#)-ents at t e Pag/I(ig Offi#e 0H12F) in Ce() B)siness Pa!3, I noti#e" t at -* I1 #a!" ol"e! was -issing f!o- -* (ag w en I was as3e" fo! i"entifi#ation (* t e loan offi#e!. .. Insi"e #a!"s, t e I1 #a!" ol"e! we!e t e following i"entifi#ation

P ilippine/iss)e" 1!i+e!4s Li#ense Co-pan* I1 at Ra"isson Bl) Hotel Ce() Intelle#a!e H2O Ca!" ol"e! an" its

%. T at "iligent effo!ts to lo#ate t e I1 #a!" #ontents a" p!o+e" f)tile5

6. T at I a- e7e#)ting t is affi"a+it to attest to t e t!)t of t e fo!egoing fa#ts an" to fa#ilitate -* !e8)est fo! !epla#e-ent i"entifi#ation #a!"s.

IN WITNESS WHEREOF, I a+e e!e)nto affi7e" -* signat)!e t is .$st "a* of No+e-(e! .&$% at Ce() Cit*, P ilippines.

MA. APRIL MAE V. MENDOZA Affiant SUBSCRIBED AND SWORN TO (efo!e -e, a nota!* p)(li# in an" fo! Ce() Cit*, t is .$st "a* of No+e-(e! .&$%. T e affiant pe!sonall* signe" t e fo!egoing inst!)-ent (efo!e -e an" a+owe" )n"e! penalt* of law to t e w ole t!)t of t e #ontents of sai" inst!)-ent. 1o#. No. 99..5 Page No. 99.5 Boo3 No. 99.5 Se!ies of .&$%.