Republic of the Philippines )

City of Dumaguete ) S.S.

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

AFFIDAVIT OF LOSS

I, SHELLA MARIE C. DEGUIA, of legal age, Filipino, widow, and a

resident of Dumaguete City, Negros Oriental, after having been sworn in
accordance with law, hereby deposes and states the following that:

1. I am the surviving spouse of SALDE SALCEDO DEGUIA who died

last September 6, 2017;

2. My husband is a plan holder of St. Peter Life Plan under Contract No.
N14249359C;

3. He was subsequently issued a St. Peter Life Plan Agreement.

However, when he died, I tried to look for the said agreement. But
the same could no longer be located.

4. Despite diligent search and efforts to locate said agreement, I could

not find the same such that I now believe that it is now lost beyond
recovery;

5. As such, I am executing this affidavit to attest to the veracity of the

foregoing facts and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________ in Dumaguete City, Philippines.

SHELLA MARIE C. DEGUIA

CRN 0111-2039499-6
Affiant

SUBCRIBED AND SWORN TO before me this

__________________in Dumaguete City, Philippines, affiant exhibiting to
me as competent proof of identity the above described ID.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.