REPUBLIC OF THE PHILIPPINES)

PASIG CITY ) S.S.

AFFIDAVIT OF LOSS

I, GRACE PATRICIA W. VILCHEZ-CUSTODIO, of legal age, Filipino, and with office

address at Suite 2404 Discovery Centre, 25 ADB Avenue, Ortigas Center, Pasig City, after
having been duly sworn in accordance with law, state that:

1. I am one of the Senior Partners of GERODIAS SUCHIANCO ESTRELLA LAW

FIRM, a partnership duly organized and existing under and by virtue of the laws of the
Philippines, and with office address at Suite 2404 Discovery Centre, 25 ADB Avenue, Ortigas
Center, Pasig City.

2. I am one of the authorized signatories of United Coconut Planters Bank (UCPB)

Account Number 001771103040.

3. On 08 February 2017, a Managers Check with Number 000000000020814

payable to UCPB 32nd Street Branch FAO Bureau of Internal Revenue in the amount of Thirty-
Nine Thousand (PhP39,000.00) was processed.

4. Despite diligent efforts to locate the Managers Check, the same could not be
found. Thus, I am constrained to declare it as lost.

5. I am executing this Affidavit to attest to the truth of the foregoing and for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I have affixed my signature this __ day of March 2017 in Pasig
City.

GRACE PATRICIA W. VILCHEZ-CUSTODIO

Senior Partner

SUBSCRIBED AND SWORN to before me this __ day of March 2017 in Pasig City,
affiant exhibiting to me her Community Tax Certificate No. 26397731 issued on 07 January 2017
in Pasig City, as well as competent evidence of her identity in the form of Tax Identification
Number 178-966-863.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2017.