REPUBLIC OF THE PHILIPPINES)

_________________________) S.S.

AFFIDAVIT OF LOSS

I, HELEN D. ROSALES, Filipino, of legal age, married and a resident of

328 Brgy. Tulay Ibaan, Batangas after having been duly sworn to in
accordance with law, depose and state that:

1. I am the owner of Fernando Airbase Savings & Loan

Association, Inc. (FABSLAI) Savings Account with no. 6352;

2. As of the date herein indicated, the passbook of the said

account cannot be located and/or lost for reasons unknown
to me and beyond my control;

3. I am executing this affidavit for the purpose of obtaining

access to the funds contained in the said Savings Account
and to do all acts pertinent thereto.

IN WITNESS WHEREOF, I have hereunto set my hands

this ___________________ in _____________________ Philippines.

HELEN D. ROSALES

Affiant

SUBCRIBED AND SWORN TO before me

this ___________________in_______________________Philippines, affiant
exhibiting to me her _______________________ as proof of identification
issued in _________________ on __________________.

Doc. No. _____;

Page No. _____; NOTARY PUBLIC
Book No. _____;
Series of 2018