Republic of the Philippines)

Province of Quirino) S.S.

Municipality of Diffun)
x--------------------------x

AFFIDAVIT OF LOSS
I, RICHILOU P. ABAYA, Filipino citizen, of legal age, married and a
resident at Brgy. Quirino, Cordon, Isabela, after having been duly sworn
to in accordance with law, hereby depose and state:

1. That I am the lawful owner of the blue HUAWEI CELLPHONE with Globe
SIM Card No. 0977-310-0824;

2. That the said CELLPHONE was stolen while charging on November 25,
2019 at around 9:00 AM in our residence. A thief went inside our house
and stole the said CELLPHONE as seen on the CCTV footage;

3. That diligent effort to locate the CELLPHONE proved futile;

4. As such, I am executing this affidavit to attest the veracity of the

foregoing facts and circumstances and for whatever legal intent and
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of

February 2019 at Diffun, Quirino, Philippines.

RICHILOU P. ABAYA
Affiant
ID NO. _________________

SUBSCRIBED and SWORN TO before me on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of
identity.
Signed this 22nd day of February 2019 at Diffun, Quirino.
WITNESS MY HAND AND SEAL.

Atty. MA. KAREN A. BALDONADO-GUILLERMO

Notary Public
Until December 31, 2019
Doc. No. 382; PTR No. 27033522/01-03-2019
Page No. 78; Lifetime IBP No. 17396/05-20-2017
Book No. 08; ROLL No. 67812/05-26-2017
Series of 2019. MCLE Exemption
(MCLE Governing Board Order No. s-2008)
Diffun, Quirino