AFFIDAVIT OF LOSS

I, RODELIO V. STA. ANA, Filipino, of legal age, single, and a

resident of 120 Kagitingan Street, Brgy. Caniogan, Pasig City after having
been sworn to in accordance with law, hereby depose and say:

1. That on April 2018, I pledged a cellphone unit Lenovo A500,

Serial No. 867372022997022 in the amount of five hundred
(₱500.00) pesos with MZE CELLURAR PHONES AND GADGETS
SHOP at NAPICO, Manggahan, Pasig City for which an official
receipt was issued by the said store;

2. That on 6 April 2018, the said official receipt was misplaced and
its whereabouts cannot anymore be ascertained despite diligent
search made and undertaken;

3. That earnest efforts were exerted to locate the same but to no

avail and I now consider it lost and beyond recovery;

4. That I attest to the truth of all the foregoing statements of facts

and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day

of April 2018 at Pasig City, Philippines.

RODELIO V. STA. ANA

Affiant

REPUBLIC OF THE PHILIPPINES)

CITY OF PASIG ) S.S.
X - - - - - - - - - - -- - - - - - - - - - -X

SUBSCRIBED AND SWORN to before me this 7th day of April2018,

at Pasig City, Philippines. Affiant personally appeared and exhibited to me
his COMELEC VIN 7403-0164A-A2389RVS10000, as competent proof of
his identity.

Doc. No. : ______;

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Book No.: ______;
Series of 2018.