AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES )

CITY OF __________________________ ) S.S.

I, CHERYL SAGAUINIT AQUINO, of legal age, single, residing at 926 Tower I Sun
Residences, Manila, after being sworn in accordance with law, depose and say:

1. That I am an employee and a branch officer at Mercury Drug Store-Libertad Pasay

Branch, Metro Manila, Philippines;

2. That in my everyday way to and from the place of work, I always commute in a
Jeepney or FX/Utility Vehicle (UV), carrying my hand-bag containing my valuables,
like my wallet, which holds my ATM Cards, Credit Cards, Mercury Drug company ID,
Sun Residences RFID and my Professional Regulation Commission (PRC)
License/Card No. 43335 (issued on April 25, 2015, valid until April 16, 2018);

3. However, In the morning of August 24, 2017, at about 5:20AM, after alighting
from a FX utility vehicle and while walking going to my place of work, two (2) men
riding in tandem on a motorcycle suddenly grabbed my handbag and threatened to
shoot me if I refused to give my bag to them, to which I fearfully obliged due to the
imminent threat;

4. That, immediately thereafter, I reported the incident to the nearest police station,
which conducted a follow-up operation, but they failed to find the robbers and
recover my belongings;

Photocopy of POLICE CERTIFICATION issued by Buendia Police Community Precinct

is hereto attached;

5. That I have to secure for new or request for the re-issuance of my Professional
Regulation License/ID, Sun Residences RFID, Mercury Drug company ID, ATM
cards, Credit Cards in furtherance of my personal transactions and such other
transactions which may require the presentation of the aforementioned IDs/Cards;

6. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have set my hand this _________ day of _________, in __________________.

CHERYL SAGAUINIT AQUINO

Affiant

SUBSCRIBED AND SWORN to before me this ________day of ______________________2017

at_____________, Philippines, affiant exhibiting to me her ______________________________as
competent evidence of her identity issued at ________________________________ on _____________,
valid until_________.

Doc. No._______;
Page No.______;
Book No.______;
Series of 2017.