REPUBLIC OF THE PHILIPPINES )

City of _____________ ) S.S.

AFFIDAVIT

I, _________________, of legal age, single, Filipino citizen, and a duly

commissioned Notary Public in the City of ___________________, after having been duly
sworn in accordance with law, hereby depose and state under oath:

1. That I am a member of the Philippine Bar;

2. That I am engaged in the practice of law and is currently holding office at

___________________________;

3. That for the month of January 2023, I have notarized a number of documents;

4. That unfortunately, one (1) document that I have notarized was either lost or that
copy of which, I inadvertently failed to retain:

Doc. No. 77, Page 16, Book 1 – Special Power of Attorney

5. That despite diligent efforts to locate these documents, the same can no longer be
found;

6. That I am executing this affidavit to attest to the fact that the said document that I
have notarized in the month of December 2022 was lost or copy of which I have
inadvertently failed to retain;

7. That this affidavit is executed to attest to the truth of the foregoing facts
statements.

IN WITNESS WHEREOF, I have hereunto set my hand this _______of

__________________ in ______________________.

___________________
Affiant

SUBSCRIBED AND SWORN to before me this ________ of _________________at

Cagayan de Oro City, Philippines.

Doc. No.______
Page No.______
Book No.______
Series of 2023