REPUBLIC OF THE PHILIPPINES)

)S.S

AFFIDAVIT OF LOSS

I, RUBY G. SOBRADO, of legal age, Filipino, married and a resident of #86 Jordan 1, Brgy
Macabling Sta. Rosa City, Laguna, after having been duly sworn to in accordance with law, depose
and state:

1. That I am the registered owner of the Mobile Number 0917-737-8040 and 0951-491-
8676.

2. On May 12, 2023, I discovered the loss of my Cellphone with the said Mobile Number
under the following circumstance:

- I am at Robinson’s Galleria South located in San Pedro Laguna last May 12, 2023
while walking going to Jeep Terminal around 1pm, I discovered that my bag is open
and my cellphone is gone.

3. Despite diligent effort, I couldn’t find or locate my cellphone and I believe that it is truly
lost.

4. I am executing this affidavit to attest to the truth of the foregoing facts and for whatever
legal purposes it may serve and request to retrieve my mobile numbers.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of May 2023 in Sta Rosa City,
Laguna Philippines.

Ruby G. Sobrado
Owner

SUBCRIBED AND SWORN TO before me this day of 2022 in

, affiant exhibiting to me his Competent Evidence of Identity by way of VOTER’S
ID 0168-A issued on in Sta Rosa City, Laguna.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.