REPUBLIC OF THE PHILIPPINES )

CITY OF PUERTO PRINCESA ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS

I, MARCELO M. OBLAN III, of legal age, Filipino, married, and a resident of Floraville,
Bgy. Sicsican, Puerto Princesa City, after having been duly sworn to in accordance with law,
depose and state THAT:

1. On 6 January 2023, I purchased an Asus Gaming Laptop with Octagon Computer Store
located at Robinson’s Mall Palawan and was issued an Official Receipt as proof of purchase;

2. Upon arriving home, I opened the purchased laptop and inadvertently disposed the said
receipt thinking that it was among the rubbish papers in my bag;

3. That despite diligent search and efforts to locate the said receipt, I could not find the same
and such that I now believe that it is now lost beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to
support my application for the issuance of a new one in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand this 24 January 2023 in Puerto
Princesa City, Palawan, Philippines.

MARCELO M. OBLAN III

Affiant
DL No. D11-13-002559

SUBCRIBED AND SWORN TO before me this 24 January 2023 in Puerto Princesa City,
Philippines, Affiant personally known to me to be the same person who executed the document.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2023.