Republic of the Philippines]

Zamboanga City ] s.s.

AFFIDAVIT OF LOSS OF OFFICIAL PURCHASE RECEIPT

OF CELLULAR PHONE SAMSUNG J-7

I, KAREN KAY R. DIESTO, of legal age, Filipino, married and a resident of Maasin, Zamboanga
City, after having been sworn in accordance with law, hereby depose and state that –

1. I bought a cellular phone (Samsung J7) from the store, “Technodot Mobile
Shoppe,” located at the third floor of KCC Mall de Zamboanga sometime in March
2019;
2. An official receipt for the purchase I made was duly issued by the store’s cashier
on the day I bought the aforesaid phone;
3. Sometime in May 2019, the aforementioned phone conked out and so I turned
over the unit and the receipt to the Samsung Repair Center also located at the third
floor of KCC Mall de Zamboanga;

4. After the repair was done and my phone was returned to me, I failed to notice
whether or not I retrieved and kept the receipt; and after searching for the receipt in
my bag and in my home, I failed to locate the same;

5. I have exhausted all efforts to find the aforesaid receipt but I could not locate it;
and

6. I executed this affidavit to attest to the truth of the foregoing facts and for
whatever lawful purposes this may serve best.

IN WITNESS WHEREFORE, I hereto affixed my signature this 6th day of December, 2019 in
Zamboanga City, Philippines.

KAREN KAY R. DIESTO

Affiant

SUBSCRIBED AND SWORN to before me in Zamboanga City on 6 th day of December, 2019 by

Karen Kay R. Diesto, who is personally known to me and is the same person who executed
and personally signed the foregoing affidavit before me and acknowledged that she
executed the same.