AFFIDAVIT OF LOSS

I, ADORACION DANDAN SALES, of legal age, Filipino

citizen, married, with postal and residence address at No. B 11
L 10 P 1 Dream Ville 4, Brgy. Alapan, Imus City, Cavite,
Philippines, after having been sworn to in accordance with law
hereby depose and state:

1. That, on December 1, 2023, at around 3:15 P.M, I was

driving my four (4) wheels eBike along Alapan 1-A road,
Imus City, Cavite, when a riding in tandem snatched my
shoulder bag. The actual incident was not captured by
the CCTV cameras in the area;

2. That, the abovesaid shoulder bag contains personal

belongings, the following such as:

 Wallet pouch or Coin purse

 Eyeglass
 Medicines

3. That, the aforesaid wallet pouch or coin purse contains

Identification cards and others, the following such as:

 BDO ATM Card

 Office of Senior Citizen Affairs Card
 Discount and Loyalty Card GoTyme
 Discount and Loyalty Card Watson
 Discount and Loyalty Card SM
 PagIBIG in the name of JACKIELOU DAVID
 Cash value of P 8, 000.00

4. As such, I am executing this Affidavit of Loss to attest to

the truth of the foregoing facts and for whatever legal
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

2nd day of December 2023, at Imus City, Cavite, Philippines.

ADORACION DANDAN SALES

Affiant

SUBCRIBED AND SWORN TO before me this 2nd day of

December 2023, in Dasmariñas City, Cavite, Philippines.