REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I, LAILANIE SY, of legal age, Filipino citizen, with residence address at No. 1622
One Castilla Place Valencia, Quezon City, after having been duly sworn to in
accordance with law, hereby depose and state;

1. That I am the holder of Delivery Receipt Invoice for Ecobag Delivery to ETPI;

2. That unfortunately the above-mentioned item was lost sometime on

November 2019 when it was accidentally misplaced and despite diligent
effort to locate the same but effort found futile;

3. That I am executing this affidavit in order to attest the truth of the foregoing
facts and for all legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of August

2021 at Quezon City, Philippines.

LAILANIE SY
Affiant

SUBSCRIBED AND SWORN to before me this 19th day of August 2021 at

Quezon City, Philippines. Affiant exhibited to me her CTC/ID No.
_______________issued on ____________________ at ________________________.

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2021

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) S.S.

AFFIDAVIT OF LOSS

I, LAILANIE SY, of legal age, Filipino citizen, with residence address at No. 1622
One Castilla Place Valencia, Quezon City, after having been duly sworn to in
accordance with law, hereby depose and state;

1. That I am the holder of Cellphone and Sim Card No. 09771222944 issued by
Globe Telecommunications;

2. That unfortunately the above-mentioned item was lost on August 8, 2021

when my cellphone containing the aforesaid item was stolen by unidentified
person;

3. That I am executing this affidavit in order to attest the truth of the foregoing
facts and for all legal intents it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 19 th day of August

2021 at Quezon City, Philippines.

LAILANIE SY
Affiant

SUBSCRIBED AND SWORN to before me this 19th day of August 2021 at

Quezon City, Philippines. Affiant exhibited to me her CTC/ID No.
_______________issued on ____________________ at ________________________.

Doc. No.: _____________ NOTARY PUBLIC

Page No.: _____________
Book No.: _____________
Series of 2021