Republic of the Philippines)

City of Marikina)S.S.
Metro Manila ) S.S.

AFFIDAVIT OF LOSS
I,RENE R. BELISON, of legal age, Filipino, married and presently residing at 13 Brazil St.,
Greenheights Subdivision, Concepcion Uno, Marikina City, having been duly sworn in accordance
with law and hereby deposes and states:
1. That on June 13, 2018, I bought an Asus gold laptop with Asianic Computer Store
with model no. X542DF-DM022T-15-8250 and serial no. JINOCV187400058 at
SM City Masinag, Antipolo City;

2. That I was issued an official receipt (OR) by Asianic Computer Store for the
purchase of the said Asus laptop;

3. That upon issuance of the said OR, I always placed it inside our room drawer;

4. That sometime on March 2019, while I was at my house and about to get the said
OR to avail of the two (2) year warranty of the said laptop, I noticed that said OR
was no longer in my room drawer;

5. I diligently searched for the said OR but no to avail;

6. That I am executing this affidavit of loss to attest to the foregoing circumstances.

IN WITNESS WHEREOF, I hereby affixed my signature this 22nd day of March 2019 at
City of Marikina.

RENE R. BELISON
Affiant

SUBSCRIBED AND SWORN to before me this 22nd of March 2019, affiant Rene R.
Belison a competent evidence of his identity.

Doc No. ________;

Page No. _______;
Book No. _______;
Series of 2019.