AFFIDAVIT OF LOSS

I, MARY JANE M. BAUTISTA, Filipino, of legal age, married and with postal address at
Blk 3 Lot 12 Morning Sun Village Valdez, Floridablanca, Pampanga, after having been
duly sworn to in accordance with law, do hereby depose and say that:

1. I am the account owner of the Gcash account number 09171783968

2. That my sim card has been deactivated but unfortunately Mr. Lindon V. Tayag
send money amounting Three Thousand Pesos only (Php 3,000.00).
3. I have no longer access to my gcash account.
4. I am requesting to transfer all of my remaining funds to my new gcash account.
5. I am executing this affidavit for whatever other legal purpose it may serve;
6. I am executing this Affidavit to attest the truthfulness of all the foregoing facts.

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

____________________ in the City of _____________________.

MARY JANE M. BAUTISTA

Affiant

SUBSCRIBED AND SWORN to before me this _________ of _______, _______ in the

_____________________________ after affiant exhibiting to me her Driver’s License
with ID No. ________________________

REPUBLIC OF THE PHILIPPINES )

CITY OF ____________________) S.S.

Doc. No. ______;

Page No. ______;
ook No. ________;
Series of _______.