REPUBLIC OF THE PHILIPPINES )

) S.S.
)
X----------------------------X

AFFIDAVIT OF LOSS

I, ______________________, of legal age, Filipino, married and a

resident of ________________________, Philippines, after having been duly
sworn to an oath in accordance with law, do hereby depose and say:

That I am a holder of Robinsons Highlands Homeowners

Association, Inc. Official Receipt, as proof of payment for the 0
.0Security/Construction Bond in the amount of PHP 100,000.00, Philippine
Peso;

That lately, when I retrieved the said receipt, I noticed that it was
missing and/or lost;

That immediately thereafter, diligent efforts were exerted to locate

the same, but all was in vain;

That I believe that said receipt is now beyond recovery.

That I am executing this Affidavit in order to state under oath the

aforementioned facts and to apprise the proper authorities thereof.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________ in _______________________________ Philippines.

Affiant
___________________

SUBSCRIBED AND SWORN TO BEFORE ME, this

_____________________. Affiant presented to me her TIN ID as competent
proof of identity.