REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S.S.

AFFIDAVIT OF LOSS
I, APRIL T. INDITA, Filipino, of legal age, single and with postal address
at No. Blk.10 Lot 33 Phase II-B, Upper Gate 1, Mabuhay Homes, Pantok,
Binangonan, Rizal after having been duly sworn to in accordance with law, do
hereby depose and state:

1. That on February 12, 2019my cellular phone particularly

Samsung J5 with cellphone number 09260555869 was lost when
I wason my way home, I did not noticed that it fell out from my
bag;

2. That despite diligent and exhausted efforts exerted, the same

could no longer be found, by reason of which I am declaring
and considering the above said Employment Identification
Card as lost and beyond recovery;

3. That I have executed this affidavit to attest to the truthfulness

and veracity of all the foregoing facts and for whatever legal
intent this may serve, especially for changing the mobile
number of my Cashalo Account;

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my

signature on this 27th day of February, 2019 in Quezon City.

APRIL T. INDITA
Affiant

SUBSCRIBED AND SWORN to before me her __________________ with

ID No. ___________this27th day of February, 2019 in Quezon City.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019.