Republic of the Philippines)

Iloilo City )S.S

AFFIDAVIT OF LOSS

I, JEVAN BRITO DEPA, Of Legal Age, Filipino citizen, Single, Resident of Calao,
Dumangas, Iloilo, Philippines after being sworn in accordance with law, hereby depose
and state that:

1. I am the custodian of MOBILE CASH RECEIPTS and RETURN TO REQUEST SLIPS issued
by TRIPLE FIVE GLOBAL DIST. INC. with the following series number and date issued:

SERIES NUMBER DATE ISSUED

From: 348434 To: 348450 December 9, 2022

2. Sometime between December 12, 2022 to Deceber 13, I discovered that the MOBILE
CASH RECEIPTS and RETURN TO REQUEST SLIPS is no longer in my possession;

3. Despite my dilligent efforts in trying to locate the MOBILE CASH RECEIPTS and
RETURN TO REQUEST SLIPS I could no longer locate the same and I believe that the
MOBILE CASH RECEIPTS and RETURN TO REQUEST SLIPS are now lost and beyond
recovery.

4. As such I am executing this affidavit of loss to attest to the truth of the foregoing and
for any legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my hand this _____ day of

_______________ in the City of Iloilo, Philippines.

JEVAN BRITO DEPA

AFFIANT

SUBSCRIBED AND SWORN to before me this ___ day of ____________ at Iloilo City,
Philippines, affiant personally appearing before me and exhibiting to me his
National ID with ID No. 9128-3423-9867-5380.

Doc. No.______;
Page No.______;
Book No.______;
Series of 2022