REPUBLIC OF THE PHILIPPINES)

CALAMBA CITY, LAGUNA ) S.S.

AFFIDAVIT OF LOSS

I, ANNA BELLE Q. MURAYAMA, Filipino, of legal age, married,

with residence at B17 Lot 2-A Macaria Ville, Pacita, after having been
sworn in accordance with law, depose and say:

THAT, I was an insurance plan holder of Pacific Pension Plan

which I have fully paid and which has already matured as of this date;

THAT, Pacific Pension Plan thereafter became APEC plans which

acquired my account. However, the insurance company has already been
under rehabilitation and I want to claim the remaining amount due to
me from my accounts amounting to FIVE HUNDRED SIXTY SEVEN
THOUSAND AND ONE HUNDRED FORTY PESOS (PHP 567,140.00)
PHILIPPINE CURRENCY as of 11 April 2019 under plan subject
8017547-7;

In relation to this I was already issued a Certificate of Full-

Payment by the insurer. This Certificate was left with my mother who
was living in our house in Pacita. Upon checking with my mother she
cannot anymore find said Certificate of Full-Payment. I also checked
among my effects the said Certificate of Full-Payment but this certificate
was already misplaced and cannot be located despite diligence or best
efforts exerted, hence considered LOST FOREVER;

THAT, I am executing this affidavit of loss to attest to the

truthfulness of the above facts to support my request for release
of the remaining amounts due to me from said Insurance Company and
for whatever legal purpose it may serve.

ANNA BELLE Q. MURAYAMA

Affiant

SUBSCRIBED AND SWORN TO before me this 04th day of

February 2020 at Calamba City, affiant exhibiting to me her Driver’s
License No. D04-92-055980 with her digital picture and signature
thereto to prove her identity.
REPUBLIC OF THE PHILIPPINES)
CALAMBA CITY, LAGUNA )S.S.

AFFIDAVIT OF LOSS

I, MARIA LOURDES MAXIMO LUCIDO, Filipino, of legal age,

married, with residence at 2 Brgy. Bunggo, Calamba City, Laguna,
after having been sworn in in accordance with law, depose and say:

THAT, last July 20, 2017, I transacted with the Register

of Deeds for Laguna, Calamba Branch, Calamba City, for issuance
of Certificate of Title and was issued EPEB NO. 2017020876 and
OFFICIAL RECEIPT dated July 20, 2017;

THAT, I misplaced said EPEB and best efforts exerted

yielded negative results, hence said OR and EPEB is considered
LOST FOREVER;

THAT this affidavit is being executed to attest the

truthfulness of the above facts to support the RELEASE of the
processed documents and for whatever lawful purpose it may
serve.

AFFIANT FURTHER SAYETH NAUGHT.

MARIA LOURDES MAXIMO LUCIDO

Affiant

SUBSCRIBED AND SWORN TO before me this 4 th day of

August 2017 at Calamba City, affiant exhibiting to me her TIN
160-539-459 and CRN 0033-1502910-0 with her digital picture and
signature to prove her identity.

DOC. NO. 37;

PAGE NO. 1;
BOOK NO. V1II;
SERIES OF 2017.
 AFFIDAVIT OF LOSS OF CHECK

REPUBLIC OF THE PHILIPPINES)

CALAMBA CITY, LAGUNA }S.S.

I , SHERWIN D. BEGUICO, Filipino, of legal age, married,

presently residing at 212 Rizal Street, Calamba City, Laguna , after
being sworn in accordance with law, depose and say:

THAT sometime on October 6, 2001, I was issued a SOCIAL

SECURITY SYSTEM Check No. 0000659730 in the amount of
P20,000.00 representing Funeral expenses of late VIRGILIO R.
BALDONADO, a SS No. 03-2114211-3 CALAMBA, who died on
September 25, 2001;

THAT said CHECK was misplaced last October 12, 2001,

inside our office at Funeraria Senerez, Rizal Street, Calamba City;

THAT said misplaced CHECK cannot be found despite

diligent search, hence considered lost;

THAT this affidavit is being executed to attest to the truthfulness of

the above
fact and to request the SOCIAL SECURITY SYSTEM Office at East
Avenue, Quezon City to cancel/void said Check and issue another one
in lieu of the lost one;

AFFIANT FURTHER SAYETH NOTH.

SHERWIN D. BEGUICO
Affiant

SUBSCRIBED AND SWORN TO before me this 16TH day of

October 2001, Affiant exhibiting to me his Community Tax No.
07332957 issued at Calamba, Laguna on March 28, 2001.

ATTY. GREGORIO E. MAUNAHAN

Notary Public
Until December 31, 2001
PTR NO. 4885838,1- 02-2001 Calamba, Laguna
IBP LIFETIME OR 458742, 03 -20-98 Pasig City
Doc No. 699
Page No. 29
Book No. X
Series of 2001