SIMPLE LOST DOCUMENTS STATEMENT

In the city of Asunción, Republic of Paraguay, on [Date: e.g. 05/02/2026], appears on one side [Party A name: e.g. Juan Pérez], holder of ID No. [Party A ID: e.g. 1,234,567], domiciled at [Party A address: e.g. Asunción], hereinafter "PARTY A"; and on the other side [Party B name: e.g. María González], holder of ID/Tax ID No. [Party B ID/Tax ID: e.g. 80012345-6], domiciled at [Party B address: e.g. San Lorenzo], hereinafter "PARTY B". The parties state that they have sufficient capacity to bind themselves and agree to execute this private instrument, subject to the following clauses:

FIRST: PURPOSE

PARTY A and PARTY B agree to to declare loss of [Document: e.g. invoice, agreement, card or certificate]. This agreement shall be interpreted in good faith, according to its economic purpose and prudent Paraguayan legal practice.

SECOND: PRICE AND PAYMENT METHOD

As consideration, price, rent, contribution or economic acknowledgment, according to the nature of the act, the parties establish [No amount: e.g. statement without direct economic value]. Every payment must be documented by receipt, bank voucher or sufficient written record.

THIRD: TERM

The term or effectiveness shall be [Date of event or knowledge: e.g. 05/02/2026]. Any extension, suspension or amendment must be made in writing and physically or digitally signed by the parties.

FOURTH: OBLIGATIONS OF THE PARTIES

• The DECLARANT shall provide the information, documents or goods required to perform the agreed purpose.
• The RECEIVER shall carry out the procedure, service or authorized use diligently, in good faith and within the stated limits.
• The parties shall keep written record of deliveries, payments, changes, observations and closing of the agreement.

FIFTH: REPRESENTATIONS AND WARRANTIES

The parties declare that the stated information is true, that they act without fraud, mistake, violence or intimidation, and that they know the legal and economic scope of the obligations assumed. When applicable, report or notice shall be made to the competent authority.

SIXTH: BREACH

Serious breach, unjustified default or lack of essential cooperation shall entitle the performing party to request performance, termination or compensation that may correspond, after notice by reliable means when the nature of the obligation permits it.

SEVENTH: ADDRESSES AND NOTICES

For all purposes of this agreement, the parties establish as special addresses those indicated in the appearance section, where written communications, emails and notices related to performance of the agreement shall be valid.

EIGHTH: JURISDICTION

For any dispute arising from this instrument, the parties shall seek an amicable solution. If disagreement persists, they submit to the competent ordinary courts of the Republic of Paraguay, without prejudice to mandatory rules applicable by subject matter or territory.

TENTH: DOCUMENTS AND SUPPORTING RECORDS

The parties shall keep copies of identity documents, payment receipts, communications and other records related to this instrument. Such background may be used to evidence performance, date, delivery, receipt or any relevant circumstance of the agreement.

ELEVENTH: CONFIDENTIALITY AND GOOD FAITH

Any information exchanged because of this agreement shall be used only for its performance. The parties shall act in good faith, with reasonable cooperation and confidentiality regarding personal, commercial, patrimonial or family information that is not public.

NINTH: ACCEPTANCE

Having read this document and as evidence of agreement, the parties sign two counterparts of the same tenor and for one single effect, at the place and date indicated above.

PARTY A signature: ___________________________

PARTY B signature: ___________________________