REPUBLIC OF THE PHILIPPINES)

Province of Guimaras )S.S.

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

AFFIDAVIT OF LOSS
I, GEORGE A. DELGADO, of legal age, Filipino, married and a resident of
Barangay Rizal, Buenavista, Guimaras, Philippines, after having been duly sworn to in
accordance with law, hereby voluntarily depose and state;

1. That I was the holder/owner of an Original Receipt issued by Far Eastern

Hardware;

2. That Original Receipt was issued for the purchase of a 070 Steel Chain Saw with
Serial Number __________ with the amount of P25,000.00 Philippine Currency;

3. That said Original Receipt could no longer be found from among my personal
belongings at home, probably having been lost due to neglect in its custody and
safekeeping;

4. That despite diligent search and efforts to locate and retrieve the said Original
Receipt the same could no longer be found such that I now believe it is lost
beyond my recovery;

5. That I shall assume any responsibility or liability if in any event the said Official
Receipt is used with or without my knowledge for whatever illicit transactions;

6. That I am executing this Affidavit to attest to the truth of the foregoing statements
and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I hereunto affixed my signature this 4 th day of

November 2022 at the Province of Guimaras, Philippines.

GEORGE A. DELGADO
Affiant
RG-GUIM-BTA-RIZ-00-01

SUBSCRIBED AND SWORN to before me, a Notary Public for and in the Province
of Guimaras, this 4th day of November 2022 at New Poblacion, Buenavista, Guimaras,
Philippines. Affiant exhibited to me his Government issued Identification Card bearing his
photograph and signature as competent proof of identity.

Notary Public
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