New SC Ronis rrKETIVE: 20158 "1 B. FORMS USUALLY ATTACHED TO LEGAL DOCUMENTS (Acknowledgment by an Individual ~ One-Party Instrument) REPUBLIC OF THE PHILIPPINES) City/Municipality of. )8S. ACKNOWLEDGEMENT BEFORE ME, a Notary Public for and in the (Province/City/ Municipality) of , personally appeared with Community Tax Certificate No. issued on at and ‘Tax Identification No. (LEN) ), known to me and to me known to be the same person who executed the foregoing in- strument which (helshe) acknowledged to me as (hisher) free and voluntary act and deed, consisting of only _) pages, Jncluding this page in which this Acknowledgement is writen, duly signed by (hinvher) and (hisvher) instrumental witnesses on each and every page hereof WITNESS MY HAND AND SEAL this __at Philippines NOTARY PUBLIC Doe. No. Page No. Book No. Series Noras ro oss ruals- MutrPartyInstrumeny oo ’ rst ses PES “oni ap in he PEDIC jy sons ve ae PANE Sly peared the fallow Se emma Tt Certiiaten or rape Comm Ta Cerin ay cre Ne, Date/ Place Issued yy wn and mes 1 be he atMe persone ap USS Siena ch hey acknowledged tome SST tay a and ded, conseting of only fo Reig a in which this acknow ‘Gems Ten dl aged yom and heir instrumental Ei end pe ee WINES MY HAND AND SEAL thie ag = hapa _ NOTARY PUBLIC Pees Bas, ~ Sec owes Usiiy Arai to LauaL Dcwwesns 33 (Acknowledgment for and in behalf of a Corpertion) [REPUBLIC OF THE PHILIPPINES) Caan of 88. ACKNOWLEDGMENT EFORE ME, « Notary Puble for and in the Prine! Cipla) of thie" perscaly ap. pe Sa Gommnisy Tas Ceniente Ne ee ae on SE epee ing be epson Ine partion of Taam ahr Ital with Community Tax Cerin No. cs soctcn fe apd Tx Tetaton No rant Town ome and to mehr ee the ne person who exe the foregoing instrument fran Intaif anid eorporaton. and (hele! acknowledged to eth ‘he mes thee voluntary eurorate act and deed of —ameat ‘srpaatica— ‘This Istrument consist of nly _(_) pag, in tng pan which hi cies ly (WITNESS MY HAND AND SEAL thie NoraRY PUBLIC Page No. Book No Seregone ss Fos PLS or andi nd Coat, eer 29) Ne sequen ss vay Pat 28 a th ee ciytncesi ar Ne ‘seed on ——~ Ste eT aa Si i ey Tax Crete No, hema ete i unease) with Community Tax Co a ee hee Seda on tavknown ome and wont de anc who excel the freging inne i Tmt fe wl e ont cow of ef) age, ioladng Sots St ated SP ser on LITMESS MY HAND AND SEAL this _ oraRy PUBLIC Paes —— at Sere (lua SUBSCRIBED ax so oR aa ad a 5 ee 10 bef me this ser Community Tax Gna —Fhipiaesan NovaRy PUBLIC ¢. COMMONLY USED FORMS REPUBLICOP THE PHILIPPINES) (1TY OF MANILA 185. AFFIDAVIT OF LOSS 1 of eggs, sine and eating, __| ar baring tom daly sworn to teording to I ia depend tate: 1 That 1am the omner o «Nokia celphoe mods 650 ith nt mb L755 under eau mmber 22222 2 ‘That on he Rh of Oxtaber, 2002 wth a number a brs tod gasknge Tea caring whl geting eu of my car, my si fciese ut hive ied omy pocket bane ater | ‘Rotd yf, [hosel ted to get my said alpha fn ‘Spoke at Tt ile abe it wa otter {That er digent search nse my car andthe sts and eystordnd ping up my oie, a sad eaipone was nowhere te betund anne 44 "Tat Fam oxecuing thi fiat order to tet he truth th foreung ceumtances ad for the prpose oe ‘eathelos tothe Cite bse center 1 WITNESS WHEREOF, {have herunto nt my had ne aay of tbe, 2002 the Cay of Ma “Stereofan SUBSCRIBED AND SWORN to before me the ___ ye exited fo me he) Cry Tax asate No nicdat Pippin on