AFFIDAVIT OF LOSS

I, CHERRY JANE BACCAY DELA CRUZ of legal age, Filipino, widow, with
residence and postal address at Block 10 Lot 49, Vista Del Rio Subdivision, NHA,
Alimannao, Peñablanca, Cagayan, after having been swear to in accordance with the
law, depose and state:
1. That I am the LEGAL BENIFICIARY/CLAIMANT of BONIFACIO GADIANO
DELA CRUZ JR;

2. That sometime on June 2019, the AFPSLAI Identification Card of Bonifacio

Gadiano Dela Cruz Jr was misplaced and got lost;

3. That I have exerted diligent and extra effort to locate said policy contract but I
could not find the same such that I now believe that it is now lost beyond
recovery;

4. That I am executing this Affidavit of Loss to attest to the truth of the foregoing
facts and to support whatever legal purpose or intent this may duly serve.

IN WITNESSED WHEREOF, I have hereunto set my hand this __________day of

_____________, 2019 at ____________________________________________.

__________________________
Affiant

REPUBLIC OF TH PHILIPPINES
PROVINCE OF ______________) S.S.
CITY/MUN. OF ______________)

SUBSCRIBED AND SWORNED TO before me this _________ day of

______________, 2019 at ______________________________________.

__________________________
Notary Public
 AFFIDAVIT OF LOSS

I, CHERRY JANE BACCAY DELA CRUZ of legal age, Filipino, widow, with
residence and postal address at Block 10 Lot 49, Vista Del Rio Subdivision, NHA,
Alimannao, Peñablanca, Cagayan, after having been swear to in accordance with the
law, depose and state:
1. That I am the LEGAL BENIFICIARY/CLAIMANT of BONIFACIO GADIANO
DELA CRUZ JR;

2. That sometime on June 2019, the AFPMBAI additional policy contract of

Bonifacio Gadiano Dela Cruz Jr was misplaced and got lost;

3. That I have exerted diligent and extra effort to locate said policy contract but I
could not find the same such that I now believe that it is now lost beyond
recovery;

4. That I am executing this Affidavit of Loss to attest to the truth of the foregoing
facts and to support whatever legal purpose or intent this may duly serve.

IN WITNESSED WHEREOF, I have hereunto set my hand this __________day of

_____________, 2019 at ____________________________________________.

__________________________
Affiant

REPUBLIC OF TH PHILIPPINES
PROVINCE OF ______________) S.S.
CITY/MUN. OF ______________)

SUBSCRIBED AND SWORNED TO before me this _________ day of

______________, 2019 at ______________________________________.

__________________________
Notary Public