REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA) S.S.

A F F I D AVI T O F L O S S
I, JAMES Y. LIM, of legal age, Filipino, with business address at 48 Santiago St., San
Francisco Del Monte, Quezon City, and residence at Sophia Townhouses, 31 Catherine St., Parkway
Village, Apolonio Samson, Quezon City, after having been duly sworn in accordance with law, do
hereby depose and state:
1.
That I am a member of Tagaytay Highlands, and have been privileged to facilitate the
procurement and issuance of the benefits of such membership to my dependents and guests;
2.
That pursuant to my availment of such benefits, I procured extension membership
cards for my kin, namely Marlene S. Lim, Alex Lim, Pauline Aleth Lim, and Pamela Alyne Lim;
3.
That all the original files and documents pertaining to the above extension cards, and
the extension cards themselves, were stored at my above-stated residence;
4.
That while they were in my file and possession, the documents and extension cards for
my above-named dependents were misplaced and lost;
5.
That I took pains to look for and recover the original files and documents, including the
above extension cards, to no avail.
6.
That I am executing this affidavit for the purpose of reconstituting my records, to report
the loss of the said documents and extension cards, and for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____________, 2005, at
Quezon City, Metro Manila.

JAMES Y. LIM
Affiant

Subscribed and sworn to before me this ________ day of September, 2005, by affiant
JAMES Y. LIM, having exhibited his CTC No. 22752008, issued on January 24, 2005 at Quezon City.
NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2005.