REPUBLIC OF THE PHILIPPINES) City of Pasig) S.S.

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

AFFIDAVIT OF LOSS
I, KALA M. LAO, Filipino, of legal age, single and a resident of 44 Paris St., Green Park Village, Pasig City, Metro Manila, Philippines, after being duly sworn in accordance with law, depose and state that: 1. I am the registered owner of a certain motor vehicle, which is more particularly described as follows: Make & Type Motor No. Chassis No. : : : Audi R8 1AJK9871 YTVM190192

Yr. Model Color Plate No.

: : :

2010 Metallic red BEL 88

2. As a registered owner, I was issued a Certificate of Registration (C.R.) and an Original Receipt (O.R.) for the year 2012 by the Land Transportation Office of Pasig City, Philippines;

3. The said documents while in my possession were misplaced and could no longer be located in spite of diligent efforts to locate them;

4. I am hereby executing this Affidavit of Loss to attest to the truth of the foregoing and to support my application for the issuance of new Certificate of Registration and Original Receipt, in lieu of the ones that were lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 29th of July 2013 in the City of Pasig, Metro Manila, Philippines.

(sgd) KALA M. LAO

AFFIANT

SUBSCRIBED AND SWORN to before me, this 29th of July 2013, in the City of Pasig, Philippines, by the Affiant exhibiting to me his/her competent evidence of identity by way of her Drivers License with
no. 54321 issued by the Land Transportation Office, East Avenue, Quezon on August 29, 2011.

ALEXIS T. BO Notary Public Commission No. 8719 Until December 31, 2013 Roll Number: 87129 PTR No. 4186724 issued at Pasig City TIN 880-114-418-669 issued at Pasig Office Address: 75 ACE Building, Ortigas Ext., Pasig City IBP No. 92830 issued at Pasig City

Doc. No. 89; Page No.98 Book No.1; Series of 2013.

REPUBLIC OF THE PHILIPPINES) City of Pasig) S.S. x-----------------------x

AFFIDAVIT OF LOSS
I, KALA M. LAO, Filipino, of legal age, single and a resident of 44 Paris St., Green Park Village, Pasig City, Metro Manila, Philippines, after being duly sworn in accordance with law, depose and state that: 1. I am the registered owner of a certain motor vehicle, which is more particularly described as follows: Make & Type Motor No. Chassis No. : : : Audi R8 1AJK9871 YTVM190192

Yr. Model Color Plate No.

: : :

2010 Metallic red BEL 88

2. As a registered owner, I was issued a Certificate of Registration (C.R.) and an Original Receipt (O.R.) for the year 2012 by the Land Transportation Office of Pasig City, Philippines; 3. The said documents while in my possession were misplaced and could no longer be located inspite of exerting efforts of locating them; 4. The said documents were not in the possession of any bank institutions or lending companies by reason of encumbrances or chattel mortgage of the subject motor vehicle; 5. The said documents were not confiscated by any governments authorities in violation of R.A. 4136 and other related laws; 6. I shall assume responsibility or liability if in any event I will use these documents for whatever illicit transactions; 7. I am executing this affidavit to attest to the veracity of my statements and to support the same in the request for duplicate copies of the lost /OR/CR; 8. I bind myself criminally, civilly and administratively liable and will assume full responsibility for any 3rd party claim, and hereby hold the Land Transportation Office or any of its employees free from any liability arising from any claim for damages as a result of the approval of the registration of the motor vehicle and or issuance of replacement certificate or registration.

IN WITNESS WHEREOF, I have hereunto set my hand this 29th of July 2013 in the City of Pasig, Metro Manila, Philippines. (sgd) KALA M. LAO

AFFIANT