REPUBLIC OF THE PHILIPPINES)

)S.S

AFFIDAVIT OF LOSS

I, MA THERESA MARTINEZ VERGARA, of legal age , Filipino with address at 2 COMETS LOOP BLUE
RIDGE B. QUEZON CITY, after having duly sworn to in accordance with the law do herby depose and
state that;

1. I am the holder of PNB Prime Pesos Money Market Fund confirmation of participant No.
1700191317 with a corresponding participating Trust Agreement No. 01019791

2. I have discovered that I lost the above-mentioned certificates;

3. I am executing this affidavit of loss to support my withdrawal of my participation in the PNB

UITF and credit proceeds to my/our settlement account number 160710113750
maintained in ESCOLTA PNB Branch,

In WITNESS WHEREOF, the undersign Ins signed these presents at the

__________________________________, Philippines on this 7th Day of December ,2020

MA. THERESA MARTINEZ VERGARA

AFFIANT

Subscribed and sworn to before me in the __________________________, Philippines on the 7 th day of

December, 2020. The affiant exhibiting to the Philippine_________________________ issued on
___________________________ at ____________________________________and valid until__________________________.

NOTARY PUBLIC

Doc No.133
Page No.28
Book No.1
Series of 2020