AFFIDAVIT OF LOSS

I ROSALINA M. PEREZ o f legal age, F i l i p i n o , m a r r i e d , a n d resident of Barangay

#31 Brgy. San Gregorio Malvar, Batangas, after being duly sworn according to law,
hereby depose and state that:

1. I am the owner of the lost counter receipt of my product;

2. Sometime on March 10, 2024, around 4:30 pm in Binan, Laguna, I lost the
above counter receipt under the following circumstances;
3. Despite diligent efforts exerted, I could no longer locate, find, or recover the
delivery receipt of my product, and to the best of my knowledge, the same is truly
lost;
4. The said counter receipt of my product has not been confiscated by any
officer of the law or the issuing office or agency due to the violation of any law, statute,
order, rule, or regulation;
5. If the lost counter receipt of my product should hereafter be found or
located, I undertake to forward or surrender the same to RE-SAL MARKETING
CORPORATION for appropriate return;
6. I am executing this Affidavit to attest to the truth of the foregoing
statements and to request the issuance of a new counter receipt instead of the one that
was lost.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set m y hand this 1 4 d a y o f

M a r c h 2 0 2 4 a t Malvar, Batangas.

ROSALINA M. PEREZ
Affiant

SUBSCRIBED AND SWORN to before me this 1 4 t h d a y o f M a r c h

2 0 2 4 , affiant exhibited to me her competent evidence of Identity by National
Identification ID number 5068-7485-4916-0137 way of issued at Malvar, Batangas on
June 19, 2022.

Doc. No. ;
Page No.
;
Book No.
;
Series of
2024.