Republic of the Philippines

City of Zamboanga )s.s.

X------------------------------------X

AFFIDAVIT OF LOSS

I, ALFREDO C. SEBASTIAN, of legal age, married, Filipino citizen and a resident

of Veterans Ave., Tetuan, Zamboanga City, Philippines, after having been duly sworn to
in accordance with law, depose and say, that:

1. I am the owner of SUNFLOWER FOOD CENTER, with business address at

Veterans Ave., Tetuan, Zamboanga City;

2. Sometime in __________, I obtained a delivery receipt from NCCC Super

Market, Sta. Ana-Gempasaw Ext. Street, Davao City, to defray expenses related
to the official transactions of said Company and as such I was issued various
receipts by companies with whom I have had business dealings. The receipts
were kept in the drawer of my table at the office where I usually keep all my other
official documents and items;

3. Upon the preparation of my liquidation report in relation to the above-mentioned

documents, I discovered that a Delivery Receipt was missing;

4. I exerted diligent efforts to look and locate for said Delivery Receipt but all such
endeavors proved futile and to no avail;

5. I make these statements under oath and in good faith to establish the fact of the
loss of the above-mentioned Delivery Receipt;

6. I execute this Affidavit to attest to the truth of the foregoing facts based on
personal knowledge and authentic records and for whatever legal purpose it may
serve.

N WITNESS WHEREOF, I have hereunto set my hand on this 8th day of March
2016 at Zamboanga City, Philippines.

ALFREDO C. SEBASTIAN
Affiant

SUBSCRIBED AND SWORN to before me on this 8th day of March 2016 in the
City of Zamboanga, Philippines, Affiant ALFREDO C. SEBASTIAN exhibited to me his
TIN ID bearing No. 102-297-771 issued on __________ at Zamboanga City.

Doc No.____
Page No.____
Book No. ____
Series of 2016