REPUBLIC OF THE PHILIPPINES)

CITY OF LUCENA ) SS.

x----------------------------------------------------x

AFFIDAVIT OF LOSS

I, RODERICK F. ESCLETO, of legal age, Filipino, married, and a resident of

Brgy. Pansol, Lopez, Quezon Philippines, after having been duly sworn in accordance
with law, hereby depose and state:

1. That I am in possession of the original copy of an Armed Forces and Police

Mutual Benefit Association Incorporated (AFPMBAI) Policy Contract evidencing
that I am the Policy Holder in the said contract at their office in Lucena City last
2012.

2. That said Policy Contract was lost in January 11, 2023 and most probably was
misplaced for I can no longer find them in the place where I usually keep my
important documents.

3. That immediately upon discovery of the same I have exerted diligent efforts to
locate said Policy Contract in probable places but the same could no longer be
found and considered irretrievably lost;

4. That I executed this affidavit in order to attest to the truth of the foregoing and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 12th day of January
2023 at Lucena City, Philippines.

RODERICK F. ESCLETO
Affiant
PNP ID NO. 22A1000233

SUBSCRIBED AND SWORN to before me, this 12th day of January 2023 at
Lucena City, Philippines.

ATTY. CHRISTOPHER P. JUNIAR

Notary Public
Until December 31, 2023
Attorney’s Roll No. 77224
PTR No. 3416706 01/03/2023 Lucena City
IBP O.R. No. 256546 12/31/2022 Pasig City
Tax Identification No. 277-604-758
MCLE exempted pursuant to MCLE Governing
Board Order No. 1, s, 2008