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Republic of the Philippines)

Pasig City
) S.S.

AFFIDAVIT OF LOSS
I, [name], Filipino, of legal age, with address [address], after having been
sworn in accordance with law, hereby depose and state that:
1.

I am the owner of a black iPhone with the following specifications:


Color:
IMEI No.:
Serial No.:
Part No.
Memory:
UPC:

2.
usually do.

Black

Last October 16, 2013, I brought my iPhone to our office, as I

3.
At around 2 pm, I attended a meeting with my officemates at our
Conference Room. As I was then charging my iPhone, I left it in my room while I
attended the meeting. I left my room door open, as I usually do.
4.
Our meeting ended at around 4 pm. I then went back to my room
and it was then that I noticed that my phone was missing.
5.
I rummaged through the files stacked on my desk, and looked at
every drawer and cabinet in my room, but to no avail. I continued my search
outside my room and practically went through every nook and cranny in our
office. Still, my phone was nowhere to be found.
6.
We tried calling my iPhone. At first, it was ringing, although we
could not hear any ring tone inside our office. Later, a recorded message
answered our call saying that my phone was unattended or was beyond the
coverage area.
7.
I strongly suspect that my iPhone was stolen while I left it
unattended inside my room as I attended our meeting held at our Conference
Room.
7.

I firmly believe that my iPhone is now beyond recovery.

8.
I am executing this affidavit in order to attest to the truth of the
foregoing, and in order to report the loss of my iPhone, and for all other legal
purposes it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this [date]
at Pasig City.

[full name]
Affiant

SUBSCRIBED AND SWORN to before me this [date], affiant exhibiting


me her [id type and no.] issued at [place] on [date].

Doc. No. ;
Page No. ;
Book No. ;
Series of 2014.