Professional Documents
Culture Documents
Complaint Loss Phone
Complaint Loss Phone
QUEZONT CITY
AFFIDAVIT OF OWNERSHIP AND LOSS WITH UNDERTAKING
I, _________________________________________ of legal age, Filipino citizen and a resident of
________________________________________________________________________ with telephone
number_________________ and with office address at ___________________________________________
and office number ______________________ after being sworn in accordance with law do hereby depose
and say:
1.
That I am requesting all CMTS carriers to block the GSM handset that was lost in my possession as
owner thereof/stolen from me by an un identified person/s with particulars as follows:
Make / Model / Type
2.
That I am also requesting ________________ to block the Subscriber Identity Module (SIM) card/cell
phone number that was contained in the lost/stolen cell phone mentioned above;
9
3.
That I hereby undertake to hold free from any responsibility or shall not hold NTC and the abovementioned carriers liable for whatever claims, loss or damages and party may institute by reason of
NTCs action to permanently block the aforementioned unit from usage;
4.
That in support of this request and as proof of my ownership of said cell phone unit, I attached hereto
the following documents, after making the original available for comparison;
Any one (1) of the following:
OR
Photocopy of passport
Photocopy of drivers license
Proof of ownership (
receipt of purchase,
Sex:
Age:
M
F
below 18
40-49
18-29
50-59
30-39
60 above
Daytime
That I am executing this affidavit of ownership and loss with undertaking to attest to the veracity and
truthfulness of the foregoing declaration and to be used for whatever legal intent and purposes the same
may thus serve.
ADMINISTERING OFFICER