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Republic of the Philippines )

Province of Laguna ) Sc.


Municipality of Calauan )

AFFIDAVIT OF LOSS
I, PIERRE LEO TOLEDO DUCUSIN, of legal age, married, employee of
Hacienda Macalauan, Inc. located at Barangay Mabacan, Calauan, Laguna and
resident of 7 Belisario San Nicolas, Bayombong, Nueva Vizcaya, after having been duly
sworn to in accordance with law, hereby depose and state that:

1. I was issued a cellular phone with charger by the Company, one (1)
Lenovo A6600 Plus on June 6, 2017 under contact number 0977-8668477;

2. At about 1:30 P.M. on February 26, 2018, I left the same charging and
unattended in my room at the Staff House located at Barangay Mabacan, Calauan,
Laguna when I reported for work in the afternoon;

3. When I returned to my room at about 7:00 P.M. on even date, I noticed


that the same mobile phone was already missing;

4. I took pains to locate the said mobile phone but proved to be futile despite
diligent search hence, I considered the same lost and beyond recovery;

5. I executed this Affidavit to attest to the truth of the foregoing as for all legal
purposes it may serve.

PIERRE LEO T. DUCUSIN


Affiant

SUBSCRIBED AND SWORN to before me this ______ day of March 2018 at


_________________ by the affiant who exhibited to me his UM ID No. CRN-006-0102-
3205-3 as competent evidence of his identity.

Doc. No.______;
Page No. _____; ___________________
Book No. _____; Notary Public
Series of 2018.
Republic of the Philippines )
Province of Laguna ) Sc.
Municipality of Calauan )

AFFIDAVIT OF LOSS
I, MARIA REGENE TRINIDAD QUINTOS, of legal age, employee of Hacienda
Macalauan, Inc. located at Barangay Mabacan, Calauan, Laguna and resident of 969
Cordillera St., Pinagsanjan, Pagsanjan, Laguna, after having been duly sworn to in
accordance with law, hereby depose and state that:

1. I was issued a cellular phone with charger by the Company, one (1)
Samsung Galaxy J2 Prime on December 22, 2017 under contact number 0977-
8035373;

2. At about 11:00 A.M. on February 28, 2018, I was at the Micro Lab while
the cell phone was on the office table in the said area. I went inside the Media
Preparation room but when I went out, I heard a delivery truck from Wilkins Coca Cola
so I attended to it but when I returned, I noticed that the same was already missing;

3. I took pains to locate the said mobile phone but proved to be futile hence, I
considered the same lost and beyond recovery;

4. I executed this Affidavit to attest to the truth of the foregoing as for all legal
purposes it may serve.

MARIA REGENE T. QUINTOS


Affiant

SUBSCRIBED AND SWORN to before me this ______ day of March 2018 at


_________________ by the affiant who exhibited to me her PhilHealth ID No. 08-
051039946-7 as competent evidence of his identity.

Doc. No.______;
Page No. _____; ___________________
Book No. _____; Notary Public
Series of 2018.

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