Republic of the Philippines )

Camiling, Tarlac
)S.S

AFFIDAVIT OF LOSS
I, RONELDA TERRADO y TINOY, of legal age, Filipino citizen,
married and a resident of 559 Palimbo Caarospian, Camiling, Tarlac,
Philippines, after having been duly sworn to in accordance with law, do
hereby depose and state THAT:
1. I am a Boardwalk dealer. In connection with such dealership, my
SIM Card with number 0919-5769685 was registered with the
Boardwalk Camiling, Tarlac Outlet which is used for our
transactions;
2. Sometime in April 2014, my bag was stolen inside my store

located at the Camiling Public Market, Camiling, Tarlac while I

was busy selling merchandise to my customers;
3. My bag contained
belongings;

my

mobile

phone

and

other

personal

4. I am executing this affidavit to inform the Boardwalk Camiling,

Tarlac Outlet concerning the loss of my mobile phone containing
my above-said SIM card;
5. Finally, I am executing this Affidavit to attest to the truth of the
foregoing statements and for all legal intents and purposes it
may serve.
IN WITNESS WHEREOF, I hereunto affixed my signature this 10 th
day of January, 2017 at Camiling, Tarlac, Philippines.
RONELDA T. TERRADO
Affiant
SUBSCRIBED AND SWORN to before me on the date and place
indicated above. Affiant exhibited before me her Unified Multi-Purpose ID
Card with CRN-0033-0363881-7 issued by the Social Security System of
the Philippines.

Doc. No. _________;

Page No. _________;

Book No. _________;
Series of 2017.