Republic of the Philippines)

Makati City, Metro Manila ) S.S.

AFFIDAVIT OF LOSS
I, WILHELMINA A. POBRE, of legal age, married, Filipino citizen, with residence address at 51-G Yakal
Street, Makati City, under oath, depose and state:
(1) I, together with my husband, own a Certificate Of Participation No. 0044335 issued by Security Bank
in the principal amount of P100,000.00.
(2) On January 10, 1999 I lost the original of the above Certificate of Participation when we moved to our
new house in Makati City, during which we relocated a number of personal possessions.
(3) Diligent search of said document among our personal effects proved futile and unavailing.
(4) I am executing this affidavit to comply with the requirements of Security Bank for the reconstitution of
said document.
Affiant further sayeth naught.

WILHELMINA A. POBRE
SUBSCRIBED AND SWORN to before me this day of August 1999 in Makati City, Metro Manila, affiant
exhibiting to her Community Tax Certificate No. __________ issued on _____________ at
____________.

Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 1999