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Affidavit of Loss-Official Receipt CELPHONE

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Republic of the Philippines)

Province of Southern Leyte) s.s.


Municipality of S O G O D)
x - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, AMELIA B. LOLO, 60 years of age, Filipino and a resident of


Brgy. Catmon, St. Bernard, Southern Leyte, after having been duly
sworn to an oath in accordance with law, hereby depose and say:

l. That I purchased a cellular phone unit last January 2, 2016 at


Aerofone Cellphones and Accessories Co., located at the lobby of
Gaisano Capital, Sogod, Southern Leyte, with O.R. No. 020790, for a
Cloudfone Ice Color Black, Model ICE, IMEI 1:353222076447476;

2. That as such, I was issued with an official receipt which I placed


in the cabinet of our house;

3. That sometime on January 5, 2016, the aforementioned Official


Receipt got lost and nowhere to be found;

4. That I exerted an exhaustive efforts to locate the same but my


search proved futile as I could not locate the same up to the present;

5. That I executed this affidavit in order to attest to the truth and


veracity of the foregoing so that I may claim for a replacement or for the
warranty of the said cellphone that I bought and for whatever legal
intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 6th


day of January, 2016 in the Municipality of Sogod, Southern Leyte,
Philippines.

AMELIA B. LOLO
Affiant

SUBSCRIBED AND SWORN to before me this 6th day of January,


2016 at Sogod, Southern Leyte, Philippines. Affiant exhibited to me her
Comelec VIN. 6412-0017A-G1053ABL20000, issued at St. Bernard,
Southern Leyte.

ATTY. JOSE JULIUS P. OBUS


Public Attorney II
Pursuant to RA 9406

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