### Appendix 75

REPORT OF LOST, STOLEN, DAMAGED OR DESTROYED PROPERTY

Entity Name : DBM-CENTRAL OFFICE Fund Cluster: ______________

Department/Office: DBM/BMB-B RLSDDP No. : _____________
Accountable Officer : BELINDA A. PINOY RLSDDP Date : __________
Designation : CHIEF BUDGET AND MANAGEMENT SPECIALIST
Status of Property : (check applicable box)
x Lost Damaged
Stolen Destroyed

Property No. Description Acquisition Cost

IT-12-A-20-010-381 LAPTOP, ACER TRAVELMATES P215-52G-782P P41,392.00
NXVLUSP00C0340B2CF7600

Circumstances:

On April 28, 2023 at around 8:00 PM, I left my backpack, containing the aforementioned LAPTOP, church documents, and other
personal belongings, in a passenger van (UV Express). One minute after I alighted in front of the Fairview Terraces in Quezon City, I
realized that I only have with me my shoulder bag, plastic bag, and the props I bought in Quiapo. The van moved on so fast, hence, I
was not able to get it back. Despite diligent efforts exerted, I could no longer locate, find or recover the said laptop and to the best of
my knowledge the same is truly lost.

I hereby certify that the item/s and circumstances stated above are true
and correct. Noted by:

Belinda A. Pinoy Dir. Sofia C. Yanto-Abad

Signature over Printed Name of the Accountable Officer Signature over Printed Name of the Immediate
Supervisor
April 2, 2023 April 2, 2023
Date of Monitoring Date of Monitoring

Government Issued ID:

ID No.: 0492
Date Issued: August 2022

SUBSCRIBED AND SWORN to before me this _________ day of ____________________, affiant exhibiting
the above government issued identification card.

Doc. No. _______

Page No. _______ __________________________
Book No. _______ Notary Public
Series of _______

184
### Appendix 75

REPORT OF LOST, STOLEN, DAMAGED OR DESTROYED PROPERTY

Entity Name : Fund Cluster: ______________

Department/Office: RLSDDP No. : _____________
Accountable Officer : RLSDDP Date : __________
Designation :
Status of Property : (check applicable box)
Lost Damaged
Stolen Destroyed

Property No. Description Acquisition Cost

Circumstances:

Before the declaration of the quarantine period, the said speaker was
I hereby certify that the item/s and circumstances stated above are true key to the said room was in my custody and the duplicate was with our
and correct. Signature
Noted by: access. In between that period the ICT monitoring team came and check
over Printed computer room and the speaker is still there. Come June, 2022, Sir Ph
Name of the
School coordinator and during the transition, I noticed that the speaker was alr
Signature over Printed Name of the Teacher Property
Custodian
________________________________ _________________________
Date of Monitoring Date of Monitoring

Government Issued ID:

ID No.:
Date Issued:

SUBSCRIBED AND SWORN to before me this _________ day of ____________________, affiant exhibiting
the above government issued identification card.

Doc. No. _______

Page No. _______ __________________________
Book No. _______ Notary Public
Series of _______

184