Republic of the Philippines )

____________,_____________ ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, SANDRA C. TUCKER of legal age, Filipino, married, and a resident of Apelo St.
Malibay, Pasay City, after having been sworn in accordance with law, hereby deposes
and states the following:

1. I am owner of the phone with Globe simcard amounting to P4,300.00

2. I have recently discovered the said item is irretrievably lost last December 9, 2018 and
can no longer be found despite diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

Affiant
(Signature over Printed Name)
Competent Evidence of Identity
ID:
issued on:
at:

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 as indicated above.

Signed this ______________at ________________, ______________________, Philippines.

WITNESS MY HAND AND SEAL.

Notary Public

Doc. No.
Page No.
Book No. I
Series of