Republic of the Philippines}

Province of Cotabato }s.s

Kidapawan City }
x-------------------------------------x

AFFIDAVIT OF LOSS
I, CRISTINA BIRANG CARBONELL, of legal age, Filipino, married
and a resident of Brgy. Sudapin, Kidapawan City after having been
duly sworn to in accordance with law, do hereby depose and say;

That I am the holder of CERTIFICATE OF MEMBERSHIP issued by

Kappa Community Ministry, International, Inc. Kidapawan City;

That on April 12, 2019, the aforementioned Copy of my

CERTIFICATE OF MEMBERSHIP for DEED OF DONATION with a certain
amount of money worth of FIVE THOUSAND PESOS (P5, 000) was lost
in my possession somewhere in the vicinity of Kidapawan City;

That despite of my earnest efforts to locate the same but proved

futile, hence aforementioned Copy of CERTIFICATE OF MEMBERSHIP
for DEED OF DONATION was now considered lost and beyond
recovery;

That I am executing this statement to attest to the truthfulness

and veracity of the foregoing facts to request the Kappa
Community Ministry to issue another CERTIFICATE OF MEMBERSHIP for
DEED OF DONATION in lieu of the one lost and for whatever legal
intent and purposes which may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand below this

9th day of October 2019 at Kidapawan City, Philippines.

CRISTINA BIRANG CARBONELL

Affiant
OSCA No. 14161

SUBSCRIBED AND SWORN to before me this 9th day of October

2019 at Kidapawan City, Cotabato, Philippines. Affiant exhibited her
Identification Card Number indicated below her name.

Doc. No. 402 ATTY. OSCAR D. BAYOG

Page No. 79 Notary Public
Until December 31, 2020
Book No. 01 Roll No.18081
Series of 2019 IBP Life Time Member
IBP OR No. 1009201/9-4-2015
O.R. No. 1012991/12-15-2015
PTR No. 1946948/01-08-2019
MCLE Compliance No. VI-0013914:Valid until April 14,2022
2/F GSP Building, Quirino Drive, Kidapawan City
Notarial Com. No. 132-2019