Republic of the Philippines

City of Pagadian
Province Of Zamboanga Del Sur

AFFIDAVIT OF LOSS

Evelyn Lapinig, 23 years old. Single and a resident of Poblacion Buug, Zamboanga Sibugay .Do hereby
deposes and State:
1. That I am engaged in the business of loading cell phones.
2. That has two cell phones use in loading Branded NOKIA 3315 and 3350.
3. That on or about 12:30 in the afternoon, more or less, in my residence at Poblacion Buug
Zamboanga Sibugay. I put my two cell phones together with my cash amount of two hundred and
forty three P 243 as proceeds of the day inside a box over the bamboo bed inside my mother’s store.
4. That all of us were taking our lunch in the kitchen, where an unknown perpetrator without our
knowledge and consent took stole and carried away the two cell phones valued at the amount of
P 3,000 to my damage and prejudice.
In here of, I Hereinto affixed my signature at this _________________ day of April 2008 at Pagadian
City, Zamboanga Del Sur.

Subscribed and sworn to before me Evelyn Lapinig

Signed in my presence this _______________
day of April 2008, at Pagadian City Zamboanga del Sur.

_____________________
City Fiscal