REPUBLIC OF THE PHILIPPINES)

Glan, Sarangani Province ) S.S.

AFFIDAVIT OF LOSS
I, LELITH DELOS SANTOS MORENO, of legal age, Filipino, single and a
resident of Lot 2 Block 9 Orchids St., Cahilsot, Calumpang, General Santos City,
Philippines, after having first been duly sworn to in accordance with law, do
hereby depose and say that:

1. I am a lawful owner of a KAPA Community Ministry International, Inc.

Form;

2. I inadvertently misplaced said item and despite earnest efforts to locate

the same, it could no longer be found;

3. I now declare it lost and beyond recovery; and

4. I am executing this affidavit to attest to the truth of the foregoing facts for
all intents and purposes this may legally serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 18th

day of February, 2019 at Glan, Sarangani Province, Philippines.

LELITH DELOS SANTOS MORENO

Affiant
License No. L04-16-004227

SUBSCRIBED AND SWORN to before me this 18th day of February, 2019

at Glan, Sarangani Province, Philippines, affiant exhibited to me her valid
identification card indicated below her name.

DOC. NO.____________;
PAGE NO.____________;
BOOK NO.____________;
SERIES OF 2019.