REPUBLIC OF THE PHILIPPINES)

BATANGAS CITY ) S.S.

AFFIDAVIT OF LOSS

I, KAYE DALLANE D. ASILO, single, of legal age, Filipino, and a

resident of Batangas City, after having been duly sworn to, in accordance with
law, hereby, depose and state, THAT:

[1] I am the legal possessor of the white copies of PR 0079865 and PR

0079866;

[2] Recently, while browsing my personal documents and files, I

discovered that said items were missing;

[3] I exerted diligent efforts to find and locate the same but to no avail,
and search proved to be futile;

[4] Said items were not returned nor surrendered to me by any

keeper/founder;

[5] I am executing this affidavit to attest to the truth of all the foregoing
facts and to inform the proper authorities and for other legal purpose this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________ at Batangas City, Philippines.

KAYE DALLANE D. ASILO

Affiant
ID No.

SUBSCRIBED AND SWORN to before me, this

__________________ at Batangas City, affiant exhibiting to me her ID herein
above-described.