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Republic of the Philippines

Province of Camarines Sur

Munipality of San Fernando
I, RAFAEL DELA CRUZ CELESTE, 42 years old, married, resident of Zone 1
Brgy. Del Pilar, San Fernando, Camarines Sur and member of Bureau of Fire
Protection assigned in San Fernando Camarines Sur, after having been duly sworn to
in accordance with the law, hereby depose and say:
That on or about 4:00 oclock in the afternoon, March 20, 2015, while I
travelling going to Pinamasagan San Fernando Camarines Sur driving his motorcycle
and while about to reach the said place I noticed that my backpack was already
opened and my 9mm pistol trade mark Armscor with the serial number 1190889
together with the cell phone were missing:
That immediately I went back to the place where I passed by to search my
handgun but remain fruitless;
That I instantly reported this incident to San Fernando Municipal Police
Station, San Fernando Camarines Sur for information and for record;
That I am executing this affidavit/statement to attest the veracity of all the
above mentioned facts;

IN WITNESS WHEREOF, I hereunto set my hand this _____ day of April,








SUBSCRIBE AND SWORN to before me this _____ day of April, 2015 at

________________, affiant exhibiting to me his Government ID issued by the Bureau of
Fire Protection.