Republic of the Philippines)

Republic of the Philippines)CITY OF SANTIAGO

) S.SAFFIDAVIT OF LOSSI, MAY ANTHONETTE LAGGUI BAHOM, of legal age, Filipino, married and a resident of Everlasting St., Purok 2, Brgy. Rosario Santiago City, after having been duly sworn to in accordance with law do hereby depose and say:1. That affiant is the same person executing this affidavit of loss;2. That affiant is the legitimate owner of Check with No. 2752-20865968-1 amounting to ONE THOUSAND FOUR HUNDRED CANADIAN DOLLARS (S1,400.00) issued on February 6, 2014. by Government of Canada;3. That on May 30, 2014 the said check was lost while I was on my way to City Hall, San Andres, Santiago City where I perform and do my work as a government employee; 4. That affiant exerted earnest efforts to locate the same but to no avail;

5. That I am executing this Affidavit in order to attest to the truth of the foregoing circumstances and for the purpose of reporting the loss of my check and for the replacement of the said check by the Government of Canada.

Further, affiant sayeth naughtIN WITNESS HEREOF, I have hereunto affixed my signature this 4th day of June 2014 at Santiago City.

MAY ANTHONETTE LAGGUI BAHOM

Affiant

SUBSCRIBED AND SWORN to before me this 4th day of June 2014 at Santiago City.Doc. No.:___________Page No.:___________Book No. :__________Series of 2014