REPUBLIC OF THE 

PHILIPPINES )
CITY OF LAS PIÑAS ) SS.

AFFIDAVIT OF LOSS

I, JUNREN RADER CABUSAO, of legal age and residing/with address at 2 Narra

Street, CAA BF International Village, Las Piñas City, under oath, state:

1.     THAT on December 22, 2021, while walking along Casimiro Overpass in Las Piñas
City, my mobile phone was pick-pocketed without my knowledge;

2.     THAT the unit of my lost mobile phone is VIVO Y19, including the sim card and GCash
account number 09216372235 which is used for payroll crediting;

3.     THAT I exerted diligence efforts to locate and contact my mobile phone or identify the
culprit but to no avail and I therefore considered the same as lost and cannot be found;

4.      THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use
the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this 3 rd day of January 2022 at Las
Piñas City.

_________________________

Affiant

SUBSCRIBED AND SWORN to before me this _______________ at __________________,

Affiant exhibiting to me his Community Tax Certificate bearing No. ________________ issued
at _________________ on ___________________________.

NOTARY PUBLIC

Doc No. ________;

Page No. _______ ;
Book No. _______;
Series of 2022.