REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S.S.

JOINT-AFFIDAVIT OF LOSS
We, MARIA LOURDES VERZOSA VALENZUELA and
EDWARD ELLICO, both of legal age, of legal age, and
residents of 344S Rimpau Blvd, Los Angeles, California,
90020, after having been duly sworn to in accordance with
law, do hereby depose and state:
1. That we are temporarily staying in the Shangri-la
Hotel as tourists in the Philippines;
2. That on July 12, 2013 while about to check-out at
EDSA Shangri-la Hotel, Manila, we deposited our
luggage (six travelers bag) with the Hotels safety
deposit room since we are about to be picked-up by
my cousin;
3. That subsequently, on July 14, 2013, we found out
that our luggage no longer contained the following
effects:
a. Our American Passports duly issued to us by
the American Government;
b. Two Asiana Airlines flight itinerary tickets
issued on our name;
c. Filipiniana blouse and black miniskirt and
duty socks;
d. Jewelries chest with jewelries;
e. Natures Pearl products in plastic bag,
vitamins, anti-aging products like serum
moisturizer;
f. Presents like small pouches, dozen of aloe
vera, Vitamins E lipton; and
g. Two Philippine National Bank books, Chase
(USA) Bank Cheque Book.

4. That we reported the person by the name of Jun

Tibi of this unfortunate matter who just merely
referred us to Ms. Ricaforte;
5. That after the confrontations and dialogues with the
management of the afore-named hotel for the
recovery of the foregoing items particularly the
conduct of investigation were held, but to no avail.
Instead, we have not been extended help nor
assistance for this matter;
6. That on this very date, the person in-charge of the
EDSA Shari-la Hotel Deposit luggage section known
as Ms. Ricaforte called us up only to inform that
they did not see anything from the CCTV Camera;
7. That however, despite the foregoing diligent and
exhausted efforts exerted, the same could no longer
be recovered;
8. That for this reason, I am declaring and considering
my above-enumerated effects as lost beyond
recovery; and
9. I have executed this Affidavit to attest to the truth
and veracity of all the foregoing and for whatever
intent this might be of legal worth.
Affiant further sayeth naught.
IN WITNESS WHEREOF, I have hereunto set my hand
and affixed my signature on this 17 th day of July, 2013, in
Quezon City, Metro Manila, Philippines.

MARIA LOURDES VERZOSA

VALENZUELA
Affiant
Drivers Lic. No. B9855908
Issued by: Govt. of California

EDWARD ELLICO
Affiant
Drivers Lic. N9119530
Issued by: Govt. of California

SUBSCRIBED AND SWORN to before me on the date

and place above-written.
Doc. No._____;
Page No._____;
Book No._____;
Series of 2013.