Republic of the Philippines }

Makati City, Metro Manila }

NOTARIZED SWORN AFFIDAVIT OF LOSS

I, Armin Röhl, of legal age, German, with address at Puerto, Sto.

Domingo, Calay-Ab, Ilocos Sur, Philippines, after being sworn to in
accordance with law, hereby depose and state that:

1. On August 22 to 23, 2019, I flew Jetstar Flight No. 3K0779 from

Singapore to Angeles Clark, Pampanga.
2. I carried with me a grey soft bag with the following items inside: 2
T-shirts, 1 Oral-B toothbrush, 1 set of toiletries, 1 bag, 1 pair of
shorts, 25 pieces of underwear, 1 pair of slippers and 2 Samsung
PS.
3. The said items were purchased on various dates in the past and
from different places, and I no longer have the original receipts or
credit card statements evidencing the original purchases of the said
items.
4. In lieu of the lost original receipts or credit card statements
evidencing the original purchases of the above mentioned items, I
am now executing this Notarized Sworn Affidavit of Loss to be
presented to Jetstar.
5. I am executing this affidavit to attest to the truth of the foregoing
facts and to present my claims for my lost baggage.
6. IN WITNESS WHEREOF, I hereby affix my signature this 27th day of
September 2019 in Makati City, Metro Manila, Philippines.

______________________________
Armin Röhl
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of September

2019, affiant exhibiting to me as competent evidence of identity copy his
Passport C4KCHXVW8 issued on 12-09-2018 and valid until 12-08-2024 and
issued by the German Embassy in Manila.

Document No.
Page No.
Book No.
Series of 2019.