REPUBLIC OF THE PHILIPPINES)

TARLAC CITY. . . . . . . . . . . . . . . . )S.S.

AFFIDAVIT OF LOSS
That I, Joanna Joy S. Pagado , of legal age, married, Filipino Citizen,
resident of St Joseph Subd, Aguso, Tarlac City, after having been duly sworn
to in accordance with law do hereby depose and say:

1. That I am the holder of the following receipts:

a) Hotel accommodation receipt issued by Premiere Control Inc.;

b) Meal stubs/ receipts issued by Angeles Beach Club Resort; and
c) Meal receipt/s issued by North Head Dragon Food Corp.

2. That the following receipts were placed inside my cream wallet which
was stolen from my possession on June 9, 2018;

3. That despite diligent efforts exerted to retrieve or locate the said cream
wallet containing said receipts, among others, the same could no
longer be recovered;

4. That I am executing this affidavit to attest to the truth of the foregoing

statements and for whatever legal intent or purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day

of June, 2018 in the City of Tarlac, Philippines.

Joanna Joy S. Pagado

Affiant

SUBSCRIBED AND SWORN to before me this this 15th day of June,

2018 in the City of Tarlac, Philippines.

Doc. No. ______;

Page No.______;
Book No.______;
Series of 2018.