Republic of the Philippines)

Quezon City ) S.S

AFFIDAVIT OF LOSS

I, MARINA F. PAROLE, of legal age, Filipino Citizen and a resident of SANDOVAL,

IBA, HAGONOY, BULACAN after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I am the owner/holder of a Samsung Smartphone with mobile no.: 09657483417;

2. That the said item, was lost/stolen on June 28, 2023 along #12 Central Ave., Brgy. New
Era and despite diligent efforts to find/recover the said item, it could no longer be
found/recovered;

3. That I am executing this affidavit to attest to the veracity of my statements, in support of

my request for replacement of my lost item and for whatever legal purpose it may serve;

IN WITNESS WHEREOF, I hereunto affix my signature this June 29th, 2023 at Quezon City.

MARINA F. PAROLE
Affiant

SUBSCRIBED AND SWORN to before me this June 29th, 2023, at Quezon City.

Doc No. ________;

Page No. ______ ;
Book No. _______;
Series of 2023