Republic of the Philippines )

City of
) S. S.
AFFIDAVIT OF LOSS
That I, FRELIN L. LEE, of legal age, married, Filipino, with residence at No. 220 A.
Bonifacio Street, San Juan, after having been duly sworn to in accordance with law do hereby
depose and state:
1. That I joined the SM Three Day Sale raffle promo of SM Supermalls and was given a
raffle ticket with stub no. ________;
2. That sometime in July 2016, while I was fixing the things inside my bag, I have
noticed that the raffle ticket was missing;
3. That I took diligent efforts to look for the missing raffle ticket;
4. That I hereby pledge that I never sold, gave, handed-over and/or delivered to any
person and/or entity the aforementioned raffle ticket;
5. That I have executed this Affidavit in order to attest to the truth and veracity of the
foregoing and for whatever legal purpose it may serve.
AFFIANT STATES NOTHING FURTHER.
IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of August 2016 in
the City of ____________, Philippines.

FRELIN L. LEE
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME, this 18th of August 2016 in the City
of Manila, Philippines, affiant exhibiting to me her (Competent Proof of Identity)
_________________________________________ issued on ________________.
WITNESS MY HAND AND NOTARIAL SEAL.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2016.