Republic of the Philippines }

City of Cagayan de Oro }

AFFIDAVIT OF LOSS

I, RONNEL LICAYAN DALAGAN, of legal age, single, and a resident of Xavier

Heights, Cagayan de Oro City, after having been duly sworn in accordance to law herby
depose and say:

1. That I am a prepaid sim card holder of Globe Telecommunications bearing a

mobile no. +639275910157;

2. That on April 29, 2016, at around 7:00 o’clock in the evening, I was at Sports
Center, Cagayan de Oro, having my routine exercise.

3. That while I was jogging around the oval, I left my bag which contained my
cellphone bearing the prepaid sim card above-mentioned, on the side of the
oval;

4. That after I finished jogging, I picked-up my bag from where I left it and
noticed that my cellphone is missing;

5. That in spite of the diligent efforts I exerted to locate the said missing cellular
phone, the same could not be found and is thus considered beyond retrieve;

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

facts and for whatever legitimate purpose this may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd day of May, 2016
at Cagayan de Oro City.

RONNEL LICAYAN DALAGAN

Affiant

SUBSCRIBED AND SWORN to before me this 3rd day of May, 2016 at Cagayan de
Oro City, affiant having established to me his identity through satisfactory evidence.

Doc No. 141

Page No. 29
Book No. 01
Series of 2016