Republic of the Philippines)

Province of Southern Leyte) S. S.

City of Maasin……………)
`
AFFIDAVIT OF LOSS

I, GUILLERMO T. URAG, Filipino, of legal age, married and a resident of San Bernardo, Limasawa,
Southern Leyte, Philippines, after having been duly sworn to in accordance with law, depose and say:

1. That sometime in the year 2017, I purchased one (1) unit CHAINSAW with Serial No.
X1A9000474, Model No. 883012A, Engine No. 1E39F39150601742;

2. That relative thereto, the Official Receipt as well some important documents evidencing
ownership thereon were delivered in my favor;

3. That unfortunately however, the aforesaid Official Receipt was lost sometime in the year
2018;

4. That I have exerted my best efforts to locate and recover the aforesaid Official Receipt,
but despite diligent search made, my efforts proved futile. I now consider the same
irretrievably lost;

5. That I am executing this affidavit to attest to the veracity of the foregoing, particularly to
prove the loss of the above-mentioned Official Receipt.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _______________ at Maasin

City, Southern Leyte, Philippines.

GUILLERMO T. URAG
Affiant

SUBSCRIBED AND SWORN TO before me this ______________ at Maasin City, Southern Leyte,
Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019