REPUBLIC OF THE PHILIPPINES )

Province of Tarlac City )S.S.

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AFFIDAVIT OF LOSS

OF CELLPHONE

I, SALSA GOMEZ, Filipino, of legal age, single, and a resident of San

Vicente Blk 2, Tarlac City, Philippines, after being duly sworn in
accordance with law, depose and state:

1. That I am the lawful owner of the graphite black IPHONE CELLPHONE

with Globe SIM Card No. 0966-323-867;

2. That the said CELLPHONE I bought was loss while charging on May
31, 2020 around 9:00 PM in our residence due to flood;

3. That despite diligent search and efforts to locate the above mentioned, I
could not find the same such that I now believe that they are now lost
beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest the veracity of the

foregoing facts and circumstances and for whatever legal intent and
purposes may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this June 8th

2021 at Tarlac City, Philippines.

SALSA GOMEZ
Affiant