REPUBLIC OF THE PHILIPPINES )

__________________________) S.S.

AFFIDAVIT OF LOSS
I, ____________, of legal age, Filipino, single, and presently residing
at________________________, having been duly sworn in accordance with the law,
hereby depose and state the following:

1. That _________________ sent a package to me on ______________containing

an iPhone 15 Pro 128GB through DHL Courier, ___________________
branch with tracking number__________________;

2. That on December 12, 2023, regrettably, my package containing said

phone was lost while in the possession of DHL courier at DHL Gateway
Pasay;

3. That despite diligent efforts, I have been unable to recover the said item,
and it is acknowledged that this loss occurred during the course of DHL's
handling and delivery process;

4. That the purpose of this affidavit is solely for the compliance of insurance
claim procedures stipulated by DHL Gateway Pasay concerning the lost
iPhone 15 Pro 128GB; and

5. I execute this affidavit to attest to the truthfulness of the foregoing

information, to facilitate the necessary actions required for the insurance
claim process, and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

__________, 2023 at _________________________________

______________________
Affiant

SUBSCRIBED AND SWORN to before me this _____________ at________________,

Philippines. I hereby certify that I personally examined the affiant and that I
am satisfied that she voluntarily executed and understood this affidavit. Affiant
presented to me her UMID ID bearing number _____________________as
competent proof of her identity.

Doc No.: ___

Page No.: ___
Book No.: ___
Series of 2023.