REPUBLIC OF THE PHILIPPINES) S.S.

CITY OF MANILA )

AFFIDAVIT OF LOSS

I, EUGENE T. MATEO, of legal age, Filipino, and residing at 457 Batangas, South St.,
Ayala Alabang Vilalge, Alabang, Muntinlupa City, after having been duly sworn to in accordance
with law, hereby depose and state that:

1. That on January 16, 2013, I travelled to Bandar Seri Begawan, Brunei with Royal
Brunei Airlines with E-Ticket 6725399713305 with Confirmation Number 2RVDQN
under Flight No. BI 684;
2. That upon boarding, I was issued a corresponding Boarding Pass for the said flight;
3. That as far as I can recall, I placed the said Boarding Pass inside my passport;
4. However, when I was looking for the said Boarding Pass, I can no longer find it;
5. That I tried to find the said Boarding Pass but can no longer find it despite my earnest
efforts;
6. That I presume the said Boarding Pass dropped or fell off somewhere;
7. For the aforesaid reasons, the same is now considered lost and beyond recovery;
8. I am executing this Affidavit of Loss to attest the truth of the loss of the said
Boarding Pass and for whatever legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ______ day of

_______________ 2013, at City of Manila, Philippines.

EUGENE T. MATEO
Affiant

SUBSCRIBED AND SWORN TO before me this ______ day of _______________

2013, at City of Manila Philippines, affiant exhibited to me his ID with number ___________ as
competent proof of his identity.

Doc. No. ____

Page No ____
Book No.____
Series of 2013