Affidavit of Loss: IN WITNESS WHEREOF, I Have Hereunto Affixed My Signature This 2

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Republic of the Philippines)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x

AFFIDAVIT OF LOSS
I, JEREMIE A. SUAZO, Filipino, of legal age, married and a resident of
Jacinto Street, Brgy. 32-D, Davao City, Philippines, after being duly sworn to
in accordance with law do hereby depose and say that:
1. I am a Business Development Officer of Davies Paints Philippines,
Inc., with office address at Ground Floor Che Yong Cua & Chua
Association Bldg., N. Torres St., Cor. Villamor St., Barrio Obrero,
Davao City;
2. As such, I was issued by the company with a cellular phone with the
following specifications:
Asset Code
:
Old Asset#/Serial #:
Asset Description :
210,
Item Name

1004-2013-11-987
#1: 537897055807026
OE- Cellular Phone, Nokia Asha
Dual Sim
OE-Cellular Phone;

3. However, sometime on March 2015, such company-issued cellular


phone was lost;
4. Notwithstanding diligent efforts exerted to find it, the same was not
found, recovered, or located, hence, considered lost for all intents
and purposes;
5. I am executing this affidavit without any fraud or intent to deceive
on my part and I forever free any person from any liability that may
arise from this circumstance, and/or any entity, be it governmental
or private;
6. I am likewise executing this affidavit to attest to the truth of all the
foregoing and to apprise the company, Davies Paints Philippines,
Inc., of such fact of loss and for all other legal purposes this affidavit
may serve.
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 2nd
day of June 2015, at Davao City, Philippines.
JEREMIE A. SUAZO
Affiant
SSS I.D. No. 09-2212433-6
SUBSCRIBED and SWORN to before me, in the City of Davao, this 2 nd
day of June 2015, affiant exhibiting to me his competent evidence of identity
first written above below his name.
Doc. No. ______
Page No. _____
Book No. _____
Series of 2015.

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