Republic of the Philippines)

City of Lipa )S.S

AFFIDAVIT OF LOSS

I, JANSEL GARCIA, of legal age, Filipino and a resident of

Bagongpook, Lipa City, Batangas, after having duly sworn to, in accordance
with law, do hereby depose and state that:

1. I was in possession of a Samsung Galaxy Tab A7, which was

given by DepEd through our school (FABNHS) for academic
purposes;

2. On June 2023, I was traveling in a public utility vehicle (jeepney)

Lipa-Lemery route;

3. During the course of the journey, while the public utility vehicle
was in motion, an unknown individual made a hole in my sling
bag, which contained the aforementioned Device, along with other
personal belongings.;

4. Despite my immediate efforts to apprehend the culprit, I was

unable to do so, and the Device was taken away from my
possession against my will;

5. As such, I am executing this Affidavit of Loss to attest to the truth

of the foregoing and in support of my claim;

6. As of this affidavit's preparation, the Device has not been

recovered, and I believe it to be irretrievable.

IN WITNESS WHEREOF, I hereby set my hand this 3rd day of

August in Lipa City, Philippines.

JANSEL GARCIA
Affiant

  SUBSCRIBED AND SWORN TO before me this 3rd day of August in

Lipa City, affiant exhibiting to me his competent evidence of identity by way
of government ID.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of _____.