REPUBLIC OF THE PHILIPPINES )

______ CITY
) S. S.

AFFIDAVIT OF NON-RECEIPT AND UNDERTAKING

I, _______________ , of legal age, Filipino, and a resident of
_______________
_______________________ after having been duly sworn according to law, hereby
depose and state :
1. That I am a registered stockholder of Aboitiz Equity Ventures, Inc.

(AEV) with a total stockholdings of ______ shares to date;

That I have not received the stock dividend certificate issued in ____
totalling _____ shares:
CERT. NO.

NO. OF SHARES

REGISTERED

NAME
_____

____

________________

2. That inquiries and verifications made proved futile and fruitless and I

therefore consider the above-mentioned AEV stock certificate already

lost beyond recovery for all legal intents and purposes;
3. That I hereby declare and attest that said certificate was not sold,

transferred, pledged or in any manner encumbered by me to secure

the payment of any obligation on my part, or any other purpose;
4. That I hereby request THE HONGKONG AND SHANGHAI BANKING
CORPORATION LIMITED (HSBC) as Transfer Agent of Aboitiz Equity

Ventures, Inc. to issue the replacement certificate in lieu of the lost

certificate;
5. That in consideration for granting said request, I hereby bind and
obligate myself to hold Aboitiz Equity Ventures, Inc. and THE
HONGKONG AND SHANGHAI BANKING CORPORATION LIMITED (HSBC) their

officers, management, stockholders and agents free and harmless

from any liability to claim by any third person or entity whomsoever,
arising out of or in connection with the issuance by them of a
replacement certificate in lieu of the one which is lost.

IN WITNESS WHEREOF, I hereunto set my hand this ___th day of

_________, 2015 at ______ City, ______.

__________________
AFFIANT

SUBSCRIBED AND SWORN to before me this _____ day of

_______________
at _____, ______, affiants exhibiting to me his/her competent evidence of
identity:

Govt Issued ID

Issued on

Place
Name

NOTARY PUBLIC
Doc. No. _____________
Page No. _____________
Book No._____________
Series of 2015.