REPUBLIC OF THE PHILIPPINES)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x

AFFIDAVIT OF LOSS
I, SARAH JANE T. BONCALES, of legal age, Filipino, single, and a resident
of Davao City, after being duly sworn in accordance with law hereby depose and say
that:

1. I am the custodian of Charge Sales Invoice No. 9083014148 dated January

6, 2016, issued by BIG-E Food Corporation in favor of LTS Retail Specialists
Inc., Choice Mart Bolton Branch (formerly LTS Supermarket Inc.).

2. Upon inventory of all the Charge Sales Invoice, on or around December of

2016, it was found out that the subject Charge Sales Invoice can no longer
be located.

3. Notwithstanding diligent efforts exerted to locate it, the same was not
found nor recovered hence considered lost for all intents and purposes.

4. I attest to the truth of the foregoing circumstances and that I am executing

this affidavit to apprise any and all persons of such fact of loss and for
whatever other legal purposes this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________ at Davao City, Philippines.

SARAH JANE T. BONCALES

Affiant
SSS No. 09-3516760

SUBSCRIBED and sworn to before me, in the City of Davao, this

______________, affiant exhibiting to me his competent evidence of identity first
written above below her name.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2017.