Republic of the Philippines}

City of Baguio } s.c

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

AFFIDAVIT OF LOST
CERTIFICATE

I, JONAH W. DEYTO, of legal age, married, Filipino, a residence of No. 14-A

Sunflower St., San Luis Village, Baguio City, under oath, depose and state, That:

1. I am a sole proprietor and engaged in the business of supplying surgical

instruments and equipments under the business name and style PINES MEDICAL
TRADING;

2. On June 8, 2011, I was issued by the Office of the Department of Trade and
Industry (DTI) a CERTIFICATE OF BUSINESS NAME REGISTRATION;

3. Said Certificate was placed inside one of my personal folders for safekeeping;

4. In the second week of May 2012, the folder where I placed the above Certificate
was left inside the taxicab which I rode on my way home from the city proper;

5. I exerted diligent efforts to find the taxicab owner or driver in order for me to
recover the above folder which contained the Certificate and other personal
documents but all my efforts proved futile and I now consider it lost and beyond
recovery;

6. I am executing this affidavit to attest to the truth of the foregoing narration of facts
and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of May 2012 in
Baguio City, Philippines.

JONAH W. DEYTO
(Affiant)
SSS ID No. 01-1045762-4

Subscribed and Sworn to before me this 28th day of May 2012, in the City of Baguio,
Philippines, by the above named person, personally known and identified by me based on
competent evidence to be the same person who executed the foregoing affidavit, that she
acknowledges to me that her signature was voluntarily affixed by her in my presence; and
that she further declare that she executed this affidavit as her free and voluntary act and
deed.

WITNESS MY HAND AND SEAL

Doc. No.:______;
Page No.:______;
Book No.: _____;
Series of 2012