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REPUBLIC OF THE PHILIPPINES )

Valenzuela City ) SS.

AFFIDAVIT OF LOSS

I, JOY JEROME REYES LOPEZ, of legal age, Filipino, and a resident of


#182 San Isidro 2nd, Paombong, Bulacan, under oath respectfully state that:

1. I am the holder and in possession of TRIP TICKET No. GCMI-2018-


098804 issued by GRAND CHAMONIX MARKETING INC. located at 79
Gen. Luis St., Bagbaguin Valenzuela City, with the following
description:

DATE : 2018-10-10 02:23:15


TRUCKER’S NAME : DARNIE TRUCKING
CONTROL NUMBER : 17350
BATCH NUMBER : B-181010-0016/ B-181009-0062
STORE NAME : PUREGOLD PRICE CLUB-GUIGUINTO/ PPCI-
BAYAN GUIGUINTO

TRIP TICKET No. GCMI-2018-098473 issued by GRAND CHAMONIX MARKETING


INC. located at 79 Gen. Luis St., Bagbaguin Valenzuela City,

DATE : 2018-10-08 04:06:21


TRUCKER’S NAME : DARNIE TRUCKING
CONTROL NUMBER : 17077
BATCH NUMBER : B-181007-0194
STORE NAME : PUREGOLD-LILAC

2. That I lost the same under the following circumstances:

DATE OF LOSS : OCTOBER 10, 2018


PLACE OF LOSS : VALENZUELA CITY
REASON : MISPLACED

3. That I exerted diligent effort to locate it but was in vain for which I
now conclude that the same is now beyond recovery;

4. That I execute this affidavit to attest to the truth of foregoing set of


facts and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 15th


day of October, 2018 at Valenzuela City.

JOY JEROME REYES LOPEZ


Affiant

SUBSCRIBED AND SWORN to before me this 15th day of October, 2018 at


Valenzuela City by affiant who exhibited to me his Voter’s ID No. 1416-0052B-
H2988JRL10000.

Doc. No. _____;


Page No. _____;
Book No.______;
Series of 2018.
REPUBLIC OF THE PHILIPPINES )
Valenzuela City ) SS.

AFFIDAVIT OF LOSS

I, JOY JEROME REYES LOPEZ, of legal age, Filipino, and a resident of


#182 San Isidro 2nd, Paombong, Bulacan, under oath respectfully state that:

2. I am the holder and in possession of the SALES INVOCE with S.I. No.
1209276 issued by GRAND CHAMONIX MARKETING INC. located at
79 Gen. Luis St., Bagbaguin Valenzuela City, with the following
description:

DELIVERED TO : PUREGOLD PRICE CLUB-MALATE


VENDOR NAME : DEL MONTE PHILIPPINES, INC.
PO # : 0032111942-00
RECEIVED DATE : 2018-10-09
DR CREATION : 2018-10-09 17:13:43
PLATE NO : ACK-7177
TRUCK TYPE : ACK-7177
TRUCKERS NAME : DARNIE TRUCKING

2. That I lost the same under the following circumstances:

DATE OF LOSS : OCTOBER 9, 2018


PLACE OF LOSS : VALENZUELA CITY
REASON : MISPLACED

5. That I exerted diligent effort to locate it but was in vain for which I
now conclude that the same is now beyond recovery;

6. That I execute this affidavit to attest to the truth of foregoing set of


facts and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 15th


day of October, 2018 at Valenzuela City.

JOY JEROME REYES LOPEZ


Affiant

SUBSCRIBED AND SWORN to before me this 15th day of October, 2018


at Valenzuela City by affiant who exhibited to me his Voter’s ID No. 1416-
0052B-H2988JRL10000.

Doc. No. _____;


Page No. _____;
Book No.______;
Series of 2018.