Republic of the Philippines )

Province of Cagayan )
Municipality of Alcala ) S.S.

AFFIDAVIT OF LOSS

I, ROBERTO A. BUMALTAO, of legal age, married, and a resident of

Calantac, Alcala, Cagayan, after being duly sworn in accordance with law,
deposes and states:

1. That I am currently a Forester I of CENRO ALCALA, Department of

Environment and Natural Resources;
2. That I was issued one (1) cellular phone which is more particularly
described as follows:

SAMSUNG A12
SM: A125F/DS
ROM: 128GB/RAM 6 GB
IMEI 1: 352884
IMEI 2: 35364945
Unit Cost: P9,990.00

3. However, sometime on January 27, 2022, when we are under LAWIN

patrolling and surveillance operation at So. Mansarong, Sta. Margarita,
Baggao, I found out that said cellular phone was missing and nowhere
to be found despite diligent efforts to locate the same;
4. I am now fully convinced that the aforesaid cellular phone had been
lost forever;
5. I have executed this Affidavit freely, voluntarily and intelligently to
attest to the truth of the foregoing and for whatever legal purpose it
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of

February 2022 at Alcala, Cagayan, Philippines.

ROBERTO A. BUMALTAO
Affiant
ID:PRC 0005149

SUBSCRIBED AND SWORN to before me this 15th day of February 2022 at

Alcala, Cagayan, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2022.