REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) ss

AFFIDAVIT OF LOSS

I, FLORINDA A. GONZALES, of legal age, Filipino, single, and with residence

and postal address located at 260 Area B. Parola Binondo, Manila, after having been
duly sworn to in accordance with law, hereby depose and say: --THAT--

1. I was issued a Passbook by Divisoria Traders Development Cooperatives;

2. The said Passbook was lost sometime on December 7, 2019;

3. Despite diligent search and efforts to locate the said item, I could not find the
same such that I now believe that It is now lost beyond recovery;

4. I am executing this affidavit to establish of the foregoing facts and for

whatever legal purpose it may deem serve.

AFFIANT SAYETH NAUGHT.

FLORINDA A. GONZALES
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of ______________

2019 at the City of Manila.

Doc. No. _____; NOTARY PUBLIC

Page No. _____;
Book No. _____;
Series of 2019