Republic of the Philippines )

Province of Albay ) S.S

Legazpi City )
x-----------------x

AFFIDAVIT OF LOSS

I, CAROLINE CHAN, of legal age, Filipino citizen, married and a resident

of Legazpi City, Albay, after having been duly sworn in accordance with law,
hereby depose and state that:

1. I am the Corporate Secretary of Legazpi Grace Home Builders Supply

Incorporated;

2. On 15 January 2021, a fire occurred at the building, owned by Jan

Realty Corporation, which we are leasing as store space at F. Imperial St., Legazpi
City. Reportedly, it was due to damaged wire connections;

3. Upon return, I found that many of our merchandise were damaged and
that there was corrosion in the metal items as well as discolorations of wood,
countertops, fabrics and other items due to the heavy smoke. The partial list of
damaged stocks is hereto attached;

4. The Partial Estimated Damage for Stock Items amounts to seven

hundred twelve thousand four hundred seventy pesos and 45/100 (P712,470.45),
and four hundred seven thousand one hundred ninety pesos (P407,190.00) for the
Fixtures, Speakers, CCTV Camera, and Other Store Equipment;

5. I am executing this Affidavit to attest to the truth of the foregoing

statements and for any legal purpose it may serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of

February 2021, at Daraga, Albay, Philippines.

CAROLINE CHAN
Affiant

          SUBSCRIBED AND SWORN TO before me this 8th day of February 2021,

at Daraga, Albay, Philippines by the affiant exhibited to me her __________ ID
with No. ____________ as competent evidence of identity.

Doc. No.__
Page No.__
Book No. __
Series of 2021.
LEGAZPI GRACE HOME BUILDERS SUPPLY INC.

FURNITURES, FIXTURES, APPLAINCES, STORE EQUIPMENTS, AIRCON, CCTV AND

OTHERS

4 PC
1 S LED TRACK SPOTLIGHT BIG 3,500.00 143,500.00
4 PC
4 S LED SPOTLIGHT COBB SMALL 850.00 37,400.00
2 PC
3 S TRACKBAR 700.00 16,100.00

        -
LO
1 T CCTV CAMERA 16 CHANNELS   199,000.00

        -
PC
2 S SPEAKER 1,995.00 3,990.00
PC
5 S WALL FAN STANDARD 18" METAL BLADE 1,440.00 7,200.00

        -

    AIRCONDITIONER UNITS REPAIR SERVICE   -

    AIRCONDITIONER UNITS PARTS   -

407,190.0
0

Partial List of Damaged Stocks (HARDWARE):

kilo
23 s Finishing Nail 1" 75.00 1,725.00
kilo
22 s Finishing Nail 1 1/2" 71.00 1,562.00
kilo
13 s Finishing Nail 2" 69.00 897.00
kilo
24 s Finishing Nail 2 1/2" 69.00 1,656.00
kilo
16 s Common Nail 5" 68.00 1,088.00
kilo
14 s Common Nail 4" 62.00 868.00
kilo
12 s Common Nail 3" 66.00 792.00
kilo
12 s Common Nail 2" 66.00 792.00
kilo
21 s Common Nail 1 1/2" 68.00 1,428.00
kilo
14 s Common Nail 1" 71.00 994.00
40
0 pcs Washer 5/8 6.60 2,640.00
41 pcs GI Tee 3/4"
 67.00 2,747.00

31 pcs GI Plug 3/4" 30.00 930.00

24 pcs GI elbow 3/4 54.00 1,296.00

1 pc GI Bushing Reducer 3/4 x 1 51.00 51.00

1 pc Matsudo Submersible Pump 10,800.00 10,800.00

1 pc Fuji Welding Machine 5,400.00 5,400.00

1 pc Power Sprayer Bronze 8,042.00 8,042.00

1 pc Creston Ladder 9,200.00 9,200.00

1 pc Pump 21 gals with base 13,150.00 13,150.00

18
2 pcs Cylindrical Hinges 1" 98.00 17,836.00
15
2 pcs Cylindrical Hinges 3/4" 53.00 8,056.00

72 pcs Cylindrical Hinges 1/2" 30.00 2,160.00

24
0 pcs Cylindrical Hinges 1/4 " 15.00 3,600.00

2 pcs BI Coupling 1 1/2 120.00 240.00

6 pcs BI Elbow 11/2 x 11/4 128.00 768.00

18 pcs BI Elbow 11/2 x 90 THREADED 160.00 2,880.00

18 pcs BI Elbow 11/4 x 90 124.00 2,232.00

6 pcs BI Elbow 2 1/2 x 90 555.00 3,330.00

37 pcs BI Elbow 2 x 90 THREADED 248.00 9,176.00

6 pcs BI Elbow 3 x90 threaded 689.00 4,134.00

63 pcs BI Elbow Reducer 1/2 x 1 93.00 5,859.00

24 pcs BI Flange 1 280.00 6,720.00

49 pcs BI Flange 11/2 threaded 363.00 17,787.00

32 pcs BI Flange 11/4 330.00 10,560.00

29 pcs BI Flange 2 threaded 594.00 17,226.00

6 pcs BI Plug 1" 43.75 262.50

10 pcs BI Plug 11/2" 120.00 1,200.00

10 pcs BI Plug 11/4" 92.00 920.00

20 pcs BI Plug 2" 161.00 3,220.00

54 pcs BI reducer 11/2 x 1 128.00 6,912.00

43 pcs BI reducer 11/2 x 11/4 128.00 5,504.00

14 pcs BI Reducer 11/2 x 2 290.00 4,060.00

1 pcs BI Reducer 11/4 x 1 100.00 100.00

18 pcs BI reducer 2 x 11/4 186.00 3,348.00

23 pcs BI St Elbow 1 93.00 2,139.00

10
4 pcs BI Tee 11/2 220.00 22,880.00

6 pcs BI Tee 11/4 173.00 1,038.00

4 pcs BI Tee 2 Threaded 324.00 1,296.00

82 pcs BI Tee Reducer 11/4 x 1/2 200.00 16,400.00

31 pcs BI Tee Reducer 1/2x1 263.00 8,153.00

18 pcs BI Tee Reducer 11/2 x 1 352.00 6,336.00

10 pcs BI Tee Reducer 11/2 x 1/2 263.00 2,630.00

14 pcs Creston Spatula 1" 25.50 357.00

9 pcs Creston Spatula 2" 28.50 256.50

8 pcs Creston Spatula 3" 34.50 276.00

8 pcs Creston Spatula 4" 42.00 336.00

12 pcs Creston Spatula 5" 49.50 594.00

3 pcs WIRE BASKET ALL PURPOSE TRAY 2,100.00 6,300.00

1 pc METAL HANGING LAMP 9075-3 2,400.00 2,400.00

1 pc LED CEILING LAMP 3166-116W 3,000.00 3,000.00

1 pc LED CEILING LAMP 3158-92W 2,400.00 2,400.00

1 pc METAL HANGING LAMP 8560/3H 2,160.00 2,160.00

1 pc HANGING LAMP 8239-6P 3,900.00 3,900.00

1 pc METAL HANGING LAMPS 8560 - 3H 2,160.00 2,160.00

1 pc GLASS HANGING LAMPS BLH99103 5,700.00 5,700.00

1 pc GLASS HANGING LAMPS 6518-D6+1 3,120.00 3,120.00

1 pc METAL HANGING LAMPS 93770 3A 4,200.00 4,200.00

1 pc METAL HANGING LAMPS 8642-5 2,250.00 2,250.00

1 pc HANGING LAMPS 6489-4H 2,700.00 2,700.00

1 pc DINING SET 1-SHEEP 6 SEATER
 38,480.00 38,480.00

1 pc CENTER TABLE 9,100.00 9,100.00

1 pc SOFA BED 15,860.00 15,860.00

1 pc FOLDABLE TABLE 4,800.00 4,800.00

1 pc BARSTOOL A621 RED 3,200.00 3,200.00

1 pc BARSTOOL A621 BLUE 3,200.00 3,200.00

1 pc BARSTOOL A621 SILVER 3,200.00 3,200.00

1 pc BARSTOOL A621 WHITE 3,200.00 3,200.00

1 pc BARSTOOL A627 WHITE 3,835.00 3,835.00

1 pc BARSTOOL A627 RED 3,835.00 3,835.00

1 pc BARSTOOL A627 BLACK 3,835.00 3,835.00

1 pc BARSTOOL A623 BLACK 3,950.00 3,950.00

1 pc BARSTOOL A623 RED 3,950.00 3,950.00

1 PC Bar Table Round BLACK 5,800.00 5,800.00

2 pcs Sofa Chair with foot Rest 9,800.00 19,600.00

1 set Coffee Table Blue with 3 chair 5,200.00 5,200.00

1 set Coffee Table Green with 3 chair 5,200.00 5,200.00

1 set Coffee Table Orange with 3 chair 5,200.00 5,200.00

1 pc MODULAR CABINET WITH SYNTHETIC GRANITE 44,789.85 44,789.85

1 pc MODULAR CABINET WITH SYNTHETIC GRANITE 40,706.40 40,706.40

MODULAR L TYPE CABINET WITH SYNTHETIC 130,739.7

1 pc GRANITE 0 130,739.70

1 pc HANGING CABINET WOOD 29,447.25 29,447.25

1 pc HANGING CABINET RED 18,212.25 18,212.25

P712,470.45