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> S.S.

AFFIDAVIT OF LOSS

I, NORBERTO J. SAPINOSO, married, of legal age, with residence at Elises St. Toclong 1B,
Imus, Cavite after having duly sworn to in accordance with law depose and state that:

1. That on or about January 2017, I rode a car going to my work at Toyota

Bluebaywalk.

2. After I alighted from the car, I realized that my Iphone 6 mobile phone
was already missing including my sim card with phone number
0915538794.

3. I exerted all my efforts to find Iphone6 mobile phone in the nearby

premises but all have proven to be futile.

4. I am executing this affidavit to attest to the truth of the foregoing, and

for all legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this October 23, 2017.

NORBERTO J. SAPINOSO
Affiant

SUBSCRIBED AND SWORN to before me this October 23, 2017, affiant is personally
known to me.

Doc. No. ___;

Page No. ___;
Book No. ____;
Series of _____.