AFFIDAVIT OF LOSS

I, GRACEL W. PIEDAD, of legal age, Filipino citizen, married, with

residence and postal address at Falcatan Street, Tetuan, Zamboanga
City, having been duly sworn to an oath in accordance with law do
hereby depose and say;
1. That as a matter of habit, I always carry my wallet with me inside
my bag;
2. That yesterday December 4, 2011 at around 4pm, while inside Just
for feet, a shoe store on the 2nd floor of MINDPRO CITIMALL, I
discovered that the said wallet was no longer in my bag;
3. That the said wallet contained the following items belonging to
me:
a. RCBC ATM CARD(MY WALLET), issued in my name as account holder
issued by its Zamboanga City Branch;
b. TAX IDENTIFICATION NUMBER CARD, issued to me by the Bureau of
Internal Revenue, Zamboanga City;
c. METROBANK ATM CARD, with Account No. 0903090220803, in my name
as account holder issued by its Zamboanga City Branch;
d. RD PAWNSHOP RECEIPT, issued in the name of Adimher Santos at
Sta. Maria, Zamboanga City Branch;
4. That despite diligent search conducted by me, I could not find
the said wallet and the same should now be considered lost for all
intents and purposes.
5. That I am executing this affidavit to attest to the truth of the
above facts and for the purpose of seeking a replacement for the
said lost items before the appropriate offices/agencies.
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this 5th day of
December, 2011 at Zamboanga City.

. . . . . . . . . . . . . . . . .
GRACEL W. PIEDAD
ACKNOWLEDGEMENT
Affiant

-Oath-
Republic of the Philippines)
City of Zamboanga ........)S.S.
x - - - - - - - - - -- - -x)
SUBSCRIBED AND SWORN TO before me this 5th day of December, 2011.
Affiant Gracel W. Piedad exhibited to me her Community Tax Certificate No.
34851903, issued on December 5, 2011 at Zamboanga City.

Doc. No: 285;

Page No: 060;
Book No: 031;
Series of 2011. Atty. MICHAEL P. MOLINA, cpa
notary public
commissioned until 12.31.2011
No. 64 Estrada Street, Tetuan, ZC
IBP OR. No.847706, 01.10.11, ZC
PTR OR. No.0354282, 01.12.11, ZC
Roll No. 40612