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Republic of the Philippines )

Calamba City, Laguna ) S. S.

AFFIDAVIT OF LOSS

I, xxxxxxxxxxxxx, Filipino,
single, of legal age and a resident of
xxxxxxxxxxxxxxxxxx, Calamba City,
Philippines, after having been duly
sworn to in accordance with law, do
hereby depose and say:

1. That I am a holder of Summary


Loan Payment of Advance
Microfinancing Corporation;

2. That undesirably however, the


Summary Loan Payment was lost in my
possession;

3. That I have exerted my best


efforts to locate and recover the
aforesaid Summary Loan Payment, but
despite diligent search made, my
efforts proved futile. I now
consider the same irretrievably
lost;
4. That I am executing this
affidavit to attest to the veracity
of the foregoing particularly to
prove the loss of the above-
mentioned Summary Loan Payment.

IN WITNESS WHEREOF, I have


hereunto affixed my signature this
17th day of December 2019 at Calamba
City, Laguna, Philippines.

xxxxxxxxxxxxxxxx
Affiant
xxxxxxxxxxxxx

SUBSCRIBED AND SWORN TO before


me this 17th day of December 2019 at
xxxxxxxxxx City, xxxxxxxxxxxa,
Philippines.

ATTY. xxxxxxxxxxxxxxxxx
Notary Public
Doc. No. ______;
Until December 31, 2019
Page No.______; PTR No.
Book No.______;
Series of 2019. xxxxxxxxxxxx0/January
xxxxxxxxxxx
ROLL NO.
xxxxxxxxxxxxx/xxxxxxxxxx
xxxx
MCLE Compliance No.
xxxxxxxxxxxxxxxxx

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