REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )

City of Dumaguete )S.S.
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AFFIDAVIT OF LOSS

I, JOSE MARIA ARRIETA, Filipino, of legal age, married and a

resident of Dumaguete City, Negros Oriental, Philippines, after being duly sworn in
accordance with law, depose and state:

1. That I was a subscriber of Cruz Telephone Company with Tel No. 225-8742 from
November 3, 1999, the date of installation, until June 2018.
2. That upon subscription, I paid the amount of P770.00 and P1,000 as rental deposit and
long distance deposit, respectively, and for which an Official Receipt No. 48364 was
issued on October 6, 1999 to Water Depot, a sole proprietorship business owned and
registered under my name;
3. That I have kept the said receipt on my wallet;
4. That when I was asked to produce the said receipt, I tried to look for it but to no avail.
Considering that it has been almost 20 years since it was issued, the said receipt has
long been disregarded or maybe thrown away by me at some time;
5. That That despite diligent search and efforts to locate the above mentioned receipt, I
could not find the same such that I now believe that they are now lost beyond
recovery;
6. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
facts and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this __________________
at Dumaguete City, Philippines.

JOSE MARIA ARRIETA

SSS 07-0387430-0
Affiant

SUBSCRIBED AND SWORN to before me, this _________________ in the City of

Dumaguete, affiant exhibiting me the above proof of identity.

Doc. No. ______;

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