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Republic of the Philippines)

La Trinidad Benguet--------)
X--------------------------X

AFFIDAVIT OF LOSS

I, JOHN TAYOG, of legal age, single, Filipino citizen, with


residence and postal address at JC-317, Central Pico, La
Trinidad, Benguet, Philippines, after having been duly sworn to
in accordance with law, hereby depose and state that:

1. I am the lawful owner of a Canopy antenna duly issued in my


favor by SMARTBRO located at PLDT, Tiongsan Km.4, La
Trinidad, Benguet;

2. However, on the last week of December 2009 the said Canopy


antenna was stolen without my knowledge;

3. I exerted diligent efforts to find and locate the said


Canopy antenna but to no avail. Further, my efforts is in
vain and now I consider the same irretrievably lost and
beyond recovery;

4. Said Canopy antenna was not confiscated, revoked and or


pledged as security for any legal obligation to any third
person;

5. I am executing this affidavit to attest to the veracity of


the foregoing narration of facts and for all legal intents
and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th


day of January, 2010 at La Trinidad, Benguet, Philippines.

JOHN TAYOG
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this 28th day of January,


2010 at la Trinidad, Benguet, Philippines, affiant exhibiting his
ID No: 043371 signed this affidavit of loss in my presence and
avowed under the penalty of law to the whole truth of the
contents of the foregoing affidavit.

ATTY. JAKE AWAL SAGPAEY


Notary Public
Until December 2010
IBP NO: 777483/BAGUIO-BENGUET/01-04-10
PTR NO: 2134583/BENGUET/01-04-10
ROLL NO: 57226

DOC.NO: 254
PAGE NO: 51
BOOK NO: 1
SERIES OF 2010

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