Republic of the Philippines

City of Makati
AFFIDAVIT OF LOSS
I, BUENA P. ROJO, of leal ae, !ith "esi#ence an# postal a##"ess at $to. Ni%o,
&alisay, 'aet, Ca(a"ines No"te, afte" ha)in been #uly s!o"n to in acco"#ance !ith la!
he"eby #epose an# state*
+. &hat I !as issue#,i)en a PO-IC. by the $t. Pete" -ife Plans o" the $t.
/yacinth -ife Plans un#e" -PA No. 01+2344356
4. &hat the afo"esai# Policy !as lost an#,o" (isplace# an# coul# no lone"
be locate#6
1. &hat as a "esult of (y a#)ance# ae I coul# no lone" also locate (y
I#entification Ca"#s issue# by #iffe"ent o)e"n(ent aencies an# p"i)ate
entities6
3. &hat I e7e"te# effo"ts to locate the afo"esai# #ocu(ents but to no a)ail
5. &hat I a( e7ecutin this affi#a)it to attest to the t"uth of all the fo"eoin
facts an# fo" all leal intents an# pu"poses this (ay se")e.
IN 8I&NE$$ 8/EREO9, I ha)e he"eunto set (y han#s this 40
th
#ay of
$epte(be" 40+1, City of Makati, Philippines.
BUENA P. ROJO
Affiant
$UB$CRIBE' an# s!o"n to befo"e (e this 40
th
#ay of $epte(be" 40+1, affiant
ha)in e7hibite# his C&C No. :::::::::::, issue# on ::::::::::40+1 at
::::::::::::: City.
'oc. No. :::::
Pae No.:::::
Book No.:::::
$e"ies of 40+1
DEED OF ASSIGNMENT
KNOW ALL MEN BY THESE PRESENTS :
&his 'ee# (a#e an# e7ecute# by BUENA P. ROJO, of leal ae, 9ilipino citi;en
an# !ith "esi#ence at $to. Ni%o, &alisay, 'aet, Ca(a"ines No"te, he"einafte" "efe""e# to as
the ASSIGNOR;
- in fa)o" of <
RENE PANC/O MA=ANA, 9ilipino, (a""ie#, of leal ae an# !ith "esi#ence at
Cobanban, 'aet, Ca(a"ines No"te , he"einafte" "efe""e# to as the ASSIGNEE.
WITNESSETH :
8/EREA$, the ASSIGNOR is the P-AN /O-'ER o" beneficia"y of the
fune"al,inte"(ent se")ices he obtaine# f"o( $t. /yacinth -ife Plans > $t. Pete" -ife Plan ?
un#e" -PA No. 01+2344356
8/EREA$, as pu"e act of "atuity , he"ein A$$I=NOR !ishes to assin all his
"ihts an# p"i)ilees un#e" the sai# Policy in fa)o" of his son@in@la! he"ein A$$I=NEE6
NO8 &/ERE9ORE, fo" an# in consi#e"ation of A$$I=NORAs pu"e libe"ality an#
"atuity, he he"eby A$$I=N$ , &RAN$9ER$ an# CONBE.$ all his "ihts an# p"i)ilees
un#e" the afo"esai# policy , pa"ticula"ly the space,lot inten#e# fo" his inte"(ent at 'aet,
Ca(a"ines No"te Ce(ete"y in fa)o" of he"ein A$$I=NEE.
IN 8I&NE$$ /EREO9, the pa"ties ha)e he"eunto set thei" han#s this ::: #ay of
$epte(be" 40+1.
BUENA P. ROJO RENE PANCHO MAGANA
A$$I=NOR A$$I=NEE
$I=NE' IN &/E PRE$ENCE O9 *
_________________________ _______________________
8I&NE$$ 8I&NE$$
ACCNO8-E'=MEN&
Republic of the Philippines ?
City of Makati ?
BE9ORE ME, this ::::: #ay of :::::::::::::::::, 4003, pe"sonally
appea"e# the follo!in pe"sons *
'A&E O9 P-ACE O9
I$$UE I$$UE
BUENA P. ROJO C&C No::::::: :::::::: ::::::::::
RENE PANC/O MA=ANA C&C No. :::::::::: :::::::::::
kno!n to (e as the sa(e pe"sons !ho e7ecute# the fo"eoin inst"u(ent of 'ee#
of Assin(ent, !hich inst"u(ent consists of &8O >4? paes inclu#in the pae
on !hich this ackno!le#(ent is !"itten an# sine# at the left (a"in of each an#
e)e"y pae by the pa"ty e7ecutin this inst"u(ent an# thei" !itnesses, an# seale#
!ith (y nota"ial seal an# sai# pa"ties ackno!le#e# to (e that the sa(e is thei"
f"ee act an# #ee#.
8I&NE$$ M. /AN' AN' $EA- on this ::::: #ay of
::::::::::: 400::, at ::::::::::::::::, Philippines.
'oc. No. :::::
Pae No. :::::
Book No. :::::
$e"ies of 40+1