REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, JULIANA S. CASABUENA, of legal age, Filipino, with address at
Palumlum, Alfonso Cavite after having been sworn to in accordance with law,
hereby depose and state, that:

1. That I am in possession of Certificate of Full Payment under

LPA# R12002232R, which was issued by St. Peter Life Plan Inc.;

2. However, upon checking my files, I found out just recently that

the said Certificate of Full Payment was misplaced and cannot be
found;

3. Despite diligent search and efforts to recover said Certificate of

Full Payment the same can no longer be located;

4. I am executing this affidavit to testify before any court of justice

to substantiate the truth of each and all the said facts.

IN TRUTH WHEREOF, I have hereunto affixed my signature this 15 th day of

July 2020 at Alfonso, Cavite.

JULIANA S. CASABUENA
Affiant

SUBSCRIBED AND SWORN to before me this 15th day of July 2020 at

Alfonso, Cavite. Affiant personally appeared to this office.
WITNESS MY HAND AND SEAL.

Doc. No. 326;.

Page No. 67;
Book No. LXXXII;
Series of 2020.