REPUBLIC OF THE PHILIPPINES)

AT THE CITY OF TACLOBAN ) S.S.

AFFIDAVIT OF LOSS

I, MARY ANN T. SUAREZ, of legal age, Filipino citizen and a

resident of Burauen, Leyte, after being duly sworn to in accordance with
law, hereby depose and state:

1. That I am the owner of a STIHL chainsaw with serial number

163148361;

2. That said chainsaw was bought at Powersaw Store in

Tacloban City, Leyte and was issued an official receipt;

3. That recently I discovered that said official receipt was

missing, and that despite diligent efforts exerted for the
purpose of locating and recovering such, all said efforts
proved futile as I failed to find and recover said document to
the present;

4. That I have a well-founded belief that said document is no

longer recoverable and forever lost;

5. That I am executing this Affidavit for the purpose of attesting

to the truth of the foregoing statement, and also for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

2 nd
day of October 2019 at Tacloban City.

MARY ANN T. SUAREZ

Affiant
4PS I.d. No.
083710044-2947-00102

SUBSCRIBED AND SWORN to before me a Notary Public for and in

the Province of Leyte and Tacloban City this 2 nd day of October 2019 at
Tacloban City.

Doc. No.____;
Page No.____;
Book No. I;
Series of 2019.