Republic of the Philippines )

______________________ ) S.S.

AFFIDAVIT OF LOSS

I, LEYNEL V. TRINIDAD, of legal age, Filipino, and with office address at FCIE,
Langkaan, Dasmarinas City, Cavite, after being duly sworn to in accordance with law,
hereby depose and state:

1. That I am the HR Assistant of NISSIN-UNIVERSAL ROBINA located at

First Cavite Industrial Estate (FCIE), Brgy. Langkaan II, Dasmariñas City,
Cavite.

2. That as HR Assistant I am the custodian of company’s documents including

the STATEMENT OF ACCOUNT (Rental Sales Invoice-VAT) UO203 040
as well as the METER READING TICKET.

3. That sometime on March 2015 after a busy day of accomplishing some

paper works and company requirements, I failed to notice that the above
mentioned documents was misplaced.

4. While I tried to diligently locate the same but I was not successful in doing
so as said documents remained missing and nowhere to be found.

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

foregoing statement and for whatever legal intents and purposes this may
serve.

AFFIANT FURTHER SAYS NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this

___________________ at __________________________, Philippines.

LEYNEL V. TRINIDAD
Affiant

SUBSCRIBED AND SWORN to before me, this __________________, by the

affiant whom I have identified through Competent Evidence of Identity when she exhibited
to me her TIN No. 239-225-979.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.