AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)

____________________ ) S.S.

I, ______________, of legal age, Filipino citizen, single/married to

__________________________________ and with residence address at
____________________, do hereby depose and declare that:

1. I am the registered stockholder of the ABOITIZ EQUITY

VENTURES, INC. (AEV) shares of stock covered by the following stock
certificates (the Subject Stock Certificates):

STOCK
NO. OF DATE
STOCKHOLDER NAME CERT.
SHARES ISSUED
NO/S.

2. (Please declare the circumstances of loss on the space provided below)

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

3. The Subject Stock Certificate(s) have not been sold, pledged or in any
way encumbered
to any third party in any manner whatsoever and as of this request, I
remain to be the absolute owner of the shares of stock covered by the
Subject Stock Certificates, free from all liens and encumbrances.

4. I hereby agree to indemnify and hold the Issuer, ABOITIZ EQUITY

VENTURES, INC. (AEV) and its stock transfer agent, THE HONGKONG
AND SHANGHAI BANKING CORPORATION LIMITED (HSBC) their
respective stockholders, directors, officers, employees and
representatives, as well as their assigns and successors-in-interest, free
and harmless from any and all losses, claims, suits, liabilities and/or
damages that the latter may incur as a result of or arising from my
request for the replacement and/or actual replacement of the Subject
Stock Certificates. In the event of such losses, claims, suits, liabilities
and/or damages, I hereby agree to pay the Corporation and/or Issuer
liquidated damages equivalent to twice the fair market value or the par
value of the shares of stock covered by the Subject Stock Certificates,
whichever is higher, in addition to actual damages and attorneys fees
that the Corporation and/or Issuer, their respective stockholders,
directors, officers, employees and representatives, as well as their assigns
and successors-in-interest, may suffer as a result of this request.

5. In the event that the missing stock certificates are recovered, I shall
immediately notify
the Corporation and/or the Issuer thereof and surrender the same to the
latter.

6. I am executing this Affidavit to attest to the truth of the fore going

statements and to
request the Corporation and/or the Issuer to replace the Subject Stock
Certificate(s) at my expense.

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

_____________ at __________

____________________________
Stockholder

BEFORE ME, a Notary Public for and in the City of Cebu, this ____ day
of_____________, personally appeared:

Name Government Issued I.D. Date/Place Issued

who was identified by me through competent evidence of identity and

presented to me known to be the same person who executed the foregoing
instrument and signed the instrument in my presence, and who took an oath
before me as to such instrument.
Doc. No. ______
Page No. ______
Book No. ______
Series of 2015.