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Makati City > S.S.

AFFIDAVIT OF LOSS

I, RICKY TOKONG., married, of legal age, Filipino, with office address at Cargohaus Bldg., NAIA
Complex, Brgy. Vitalez, Paranaque City, after having duly sworn to in accordance with law depose and
state that:

1. I am employed as Driver at UBE EXPRESS INC., a corporation organized and existing under
Philippine laws, with principal address as above.

2. That on August 26, 2017, I rode a jeepney from Pasay City to Paranaque City.

3. When I alighted, I realized that my wallet was missing, which includes my BPI ATM Card.

4. I realized that I was victimized by a pickpocket.

5. I executed my best efforts to locate the same but all have proven to be futile.

6. I am executing this affidavit to attest to the truth of the foregoing, and for all legal purposes
this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of August, 2017.

RICKY TOKONG
Affiant

SUBSCRIBED AND SWORN to before me this this 29th day of August, 2017, affiant is
personally known to me.

Doc. No. ___;

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