Republic of the Philippines )

City of Tagum ) S.s.

AFFIDAVIT OF LOSS

I, RUEL GULTIANO MAGHANOY, of legal age and a resident of

Purok 4, Cambanogoy, Asuncion Davao del Norte, after having been
duly sworn to in accordance with law hereby depose and state:

1. That I am a holder of 2 BDO check booklets, passport, ONB,

Security Bank and UCPB Passbooks, ₱75,000.00 cash and my Driver’s
License issued by the Land Transportation Office (LTO) Tagum City all
of which are contained in my sling bag;

2. That on or about September 7, 2019 at 12:00PM, I checked in for

lunch at Twin Palm Kambingan, located in Brgy. Gredu, Panabo City and
left the said sling bag in my pick-up truck Ford Ranger;

3. That upon returning to my vehicle, I discovered that my sling bag

was lost or stolen.

4. That despite exerting diligent efforts to locate it, the same could
no longer be found and believed to have been stolen by an unidentified
person;

5. That after such search, I went to the Panabo City Police Station
to report the incident.

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

foregoing statements and for whatever legal purpose this may serve
best.

IN WITNESS WHEREOF, I have hereunto set my hands this

____________ in Tagum City, Davao del Norte.

RUEL GULTIANO MAGHANOY

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ___________ in

Tagum City, Davao del Norte.

Doc No. ___;

Page No. ___;
Book No. ___;
Series of 2019.