Legal Forms: AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES  )
CITY OF MANILA                             ) S.S

AFFIDAVIT OF LOSS

           I, _____________, of legal age, single and residing at______after having been duly sworn to according to law hereby depose and state:

           1. That I am the owner of a Nokia cellphone model 6150 with unit number 0917-5555555 under account number 222222;

           2. That on the 30th of October, 2002 with a number of books and packages I was carrying while getting out of my car, my said cellphone must have slipped from my pocket because after I reached my office, I hurriedly tried to get my said cellphone from my pocket but I was a little bit shocked as it was not there anymore;

           3. That after diligent search inside my car and the stairs and elevator used going up my office, my said cellphone was nowhere to be found anymore;

           4. That I am executing this affidavit in order to attest to the truth of the foregoing circumstances and for the purpose of reporting the loss to the Globe business center.

           IN WITNESS WHEREOF, I have hereunto set my hand this ___day of October, 2002 at the City of Manila.