REPUBLIC OF THE PHILIPPINES)

PROVINCE OF DAVAO DEL SUR) S.S.

IN THE CITY OF DAVAO………...)
X……………………………………….X

AFFIDAVIT OF LOSS

I, Andre Dela Cruz, of legal age, Filipino, married, and residing at

112 Nickelodeon Street Ciudad de Ezperanza, Buhangin, Davao City,
after having been sworn in accordance with law, hereby deposes and
states the following:

1. That I am owner of the MSI Laptop GE60ONC with serial

number 084931;

2. That on December 8, 2019, I discovered that said laptop can no

longer be found on my car;

3. That after diligent effort to search for it, said laptop was
nowhere to be found anymore;

4. That I am executing this affidavit in order to attest to the truth

of the foregoing circumstances.

IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day

of December, 2019 at the City of Davao.

Andre Dela Cruz

Affiant

SUBSCRIBED AND SWORN TO before me this 12th day of December

2019 in Davao City, affiant exhibited to me his SSS Identification
Card Nos. 9384 issued on April 8, 2016 in Davao City.

Doc. No. __1___

Page No. __1___
Book No. __1___
Series of 2019.