REPUBLIC OF THE PHILPPINES )

CITY OF GENERAL S A N T O S) S.S.

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AFFIDAVIT OF LOSS

I, LILIA F. GAMUTIN, of legal age, Filipino, married with postal address at Sarangani
Phase I, Brgy. San Isidro, General Santos City, after having been duly sworn to in accordance with
law, do hereby depose and say:

1. That I am the mother of JHULIA ANNE F. GAMUTIN, the one who purchased a
NIKON 5200 CAMERA at Camera Hauz, KCC Mall of Gensan, General Santos City;
2. That she was issued an Official Receipt upon purchased thereof;
3. That the said OR was lost while in my daughter’s safekeeping and diligent efforts
exerted to locate the same could not be found and is now beyond recovery;
4. That I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever purpose this may legally serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________________________

at General Santos City.

LILIA F. GAMUTIN
Affiant

SUBSCRIBED AND SWORN to before me this ______________________ at General

Santos City.

Doc. No. __________;

Page No. __________;
Book No. __________;
Series of 2015.

REPUBLIC OF THE PHILPPINES )

CITY OF GENERAL S A N T O S) S.S.
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 AFFIDAVIT OF CANCELLATION
OF DTI PERMIT

I, EDUARDO B. DUMALAG, JR., of legal age, Filipino, with postal address at Bascon
Compound, San Pedro St., Lagao, General Santos City, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am the owner/proprietor of NOOBS BOARDSHOP with business address at

Roxas St., General Santos City;
2. That I intend to cancel the DTI Permit of Noobs Boardshop from Brgy. South to Brgy.
East, General Santos City;
3. That I am executing this affidavit to attest to the truth of the foregoing facts and for the
purpose of changing the address of my DTI Permit from Brgy. Dad. South, to Brgy. Dad.
East, particularly at Roxas St., General Santos City.

IN WITNESS WHEREOF, I have hereunto set my hand this 30 th day of June, 2011 at
General Santos City.

EDUARDO B. DUMALAG
Affiant

SUBSCRIBED AND SWORN to before me this 30 th day of June, 2011 at General Santos
City, personally appeared Eduardo B. Dumalag identified by me to be the same person who executed
this instrument and exhibiting to me his Driver’s License No. L04-08-008399, bearing his photograph
and signature and acknowledged to me that the same is his free act and voluntary deed.

Doc. No. ____________;

Page No. ____________;
Book No. ____________;
Series of 2011.