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REPUBLIC OF THE PHILIPPINES) CITY OF MANILA ) S.

AFFIDAVIT OF LOSS I, Benette Mary V. Medina, of legal age, with residence at 1746 Rizal Avenue Sta. Cruz, Manila born on Nov. 2, 1981 at Doha Qatar Arabian Gulf after having been duly sworn to in accordance with law hereby depose and say; 1. 2. That I am the owner of Arabian Passport with passport no. C098648 That sometime in December of the year 2007, me and my family went out for a dinner but when we where in our family car, my mother noticed that her bag was left in the restaurant; Me and my mother went back to the said restaurant and tried to locate the bag but to no avail. The bag that was lost contained the above mentioned passport; That I am executing this affidavit to attest to the truthfulness of the foregoing and for all intents and purposes as it may serve.

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BENETTE MARY V. MEDINA Affiant Subscribed and sworn to before me on this ________ of May 2009, here at City of Manila, affiant exhibit to me his CTC no. 27009583 issued on January 17, 2009 at Manila, Philippines.

NOTARY PUBLIC

Doc No. _________. Page No. _________. Book No. _________. Series of 2009.