Republic of the Philippines ) Tacloban City ) S.S.

AFFIDAVIT OF LOSS

I, HWANG JINI, of legal age, and a resident Seoul St., Tacloban City, after

having been duly sworn to in accordance with law hereby depose and state that:

1. I am the manager of PALACE HOLDINGS CORPORATION;

2. In line with our business, we own a Dump Truck which is registered in the Land

Transportation Office with the following details:

Certificate of Registration No.: 000000

Official Receipt No.: 000000

Plate Number: 00000

3. Sometime around the second week of November, the said Dump Truck was

brought to Julita, Leyte by one of our employed Drivers;

4. While the Dump Truck was travelling through the municipality of Julita, the

PLATE NUMBER: 00000 must have accidentally fell from the Dump Truck;

5. My Driver only realized that the said plate Number was already gone when he

arrived at Tacloban City and upon realizing that he lost it, he tried to look for it;

6. Despite due effort and diligence to locate the same, all efforts turned fruitless;

7. I have executed this affidavit to report the loss of the said PLATE NUMBER:

00000, to declare it lost for all lawful intents, in preparation for my application for the issuance of a new plate number in lieu of the lost one and to attest to the veracity of the foregoing statements and declarations.

IN WITNESS WHEREOF, I have hereunto affixed my signature this day,

__________________, in the City of Tacloban, Leyte, Philippines.

HWANG JINI Affiant

SUBSCRIBED AND SWORN TO Before me a Notary Public for and in the City of

Tacloban, this day of ______________________.

Doc. No.:____ Page No.:____ Book No.:____ Series of 2015