Republic of the Philippines)

Region of__________________) S.S.

City/Municipality of _____________)

AFFIDAVIT OF LOSS OF FIREARMS

I, Dominic Santos Dalisay, Filipino, of legal age, married and a resident of

167 I.Lopez st. Mandaluyong City, Philippines, after being duly sworn in
accordance with law, depose and state:

That I am the true and licensed owner of the firearms with Serial Nos. listed
below:

1. Glock SN# BEY494

2. STI SN# SK7483
3. Taurus 38 SN# ES92744
4. S&W 38 SN# BNU3297
5. Taurus .380 SN#

That on August 18th, after hauling the heavy belongings and boxes of stuff
that I own from our Condominium, I then proceeded to my main home. I
then checked my things brought inside my room the next day, I was
shocked to have discovered that my guns were not inside my cabinet where
they are placed;
 

I then confirmed further after inspecting said cabinet, that all the guns in my
cabinet where I keep important belongings also were missing. That despite
very diligent search and efforts to locate said firearms all over the house, I
could not find the same such that I now believe that all the foregoing items
are ultimately missing and are now lost beyond recovery.

As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________
at _____________, Philippines.

AFFIANT

(JURAT)