Republic of the Philippines)

City of Mandaue. . . . . . . . .) S.S.

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

AFFIDAVIT OF LOSS
I, LEO A. BINONDO, Filipino, of legal age, and a resident of Pulpogan,
Consolacion, Cebu, Philippines, after being duly sworn in accordance with law, depose
and state:

1. That I am the holder of a Raffle Ticket No. 4718 in a raffle draw of “Ace
Hardware SM City La Consolacion Now Open” raffle promo, which I bought
sometime on the month of July 2012, for which I was issued the corresponding
Ticket Stub No. 4718.

2. That however, the said Ticket Stub No. 4718 was misplaced and got lost.

3. That despite diligent search and efforts to locate the said Ticket Stub, I could not
find the same such that I now believe that they are now lost beyond recovery.

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

foregoing facts and to support my claim as the holder of the winning ticket.

IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd day of September

2012 at Mandaue City, Cebu, Philippines.

LEO A. BINONDO
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this 3rd day of September 2012 at
Mandaue City. Affiant exhibited his PRC I.D. No. 090975 as competent proof of his
identity.

Doc. No._____
Page No._____
Book No._____
Series of 2012.