REPUBLIC OF THE PHILIPPINES ) CITY OF MANILA ) S.S.

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AFFIDAVIT OF LOSS

I, XXX, of legal age, Filipino, single and a resident of 1 Jordan Park Homes, Quezon City, after having been duly sworn to in accordance with law, depose and state THAT:

1. On November 2010, I was issued a Certified Public Accountant Identification Card by the Professional Regulation Commission in Manila; 2. Recently, I had tried to look for the said card but the same could not be found; 3. Despite diligent search and efforts to locate the said card, I could not find the same such that I believe that it is now lost beyond recovery; 4. As such, I am executing this affidavit to attest to the foregoing facts and to support the application for the issuance of a new one in lieu of the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ____day of November 2013 in Manila, Philippines.

XXX TIN No. _____________

SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines, affiant exhibiting to me his valid proof of identification. Doc. No. _____; Page No. _____; Book No. _____; Series of 2013.