Republic of the Philippines )

Balagtas, Bulacan )S.S

AFFIDAVIT OF LOSS

I, MELITA DELA CRUZ CASANAS, of legal age, Filipino, married, and with residence
address at Bambang, Bulakan, Bulacan, after having been duly sworn in accordance with law,
hereby depose and state that:

1. That on November 7, 2021, I secured a television loan in Robinson’s Balagtas,

Branch and was issued an official receipt under my name, which is described as
follows:

Date : November 7, 2021

Brand : SkyWorth
Serial No. : 106
Invoice No. : 39209

2. That as a result of the abovementioned transaction, I was issued an official

receipt after which I kept it inside a bag;

3. That when I went to wet market in Balagtas to buy some stuffs and foods, my
official receipt may have been dropped and the said receipt went missing and
may have been misplaced;

4. That despite all efforts to look for the official receipt, including searching the
place where it may have last dropped, the same was not found;

5. That I executed this Affidavit to attest the truth of the foregoing facts, to
facilitate the repair of the said television, and for any other legal purpose it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 2 nd day of September 2022 at
Balagtas, Bulacan, Philippines.

MELITA DELA CRUZ CASANAS

Affiant

SUBSCRIBED AND SWORN before me this this 2nd day of September 2022 at Balagtas,
Bulacan, Philippines. Affiant exhibited her valid proof of identity of identity COMELEC ID No.
VIN1405-0038A-F2666KAC00000-B

ATTY. CLAUDETTE C. TOLENTINO

NOTARY PUBLIC until December 31, 2020
Extended until December 31, 2022
per Supreme Court En Banc
Resolution dated July 5, 2022
Doc. No. 56; Notarial Commission B.M. No. 3795
Roll of Attorneys No. 55292
Page No. 13; PTR No. 7744807/01.04.2022/Balagtas, Bulacan
Book No. V; IBP Lifetime No. 013237/Bulacan
MCLE Comp. No. VII-0002447/04.14.25/Pasig City
Series of 2022.