8/19/2019 Affidavit of Loss Gambong
1/1
REPUBLIC OF THE PHILIPPINES)
CITY OF CEBU ) S.S.
x--------------------------------/.
AFFIDAVIT OF LOSS
I, DAISY ANN S. GAMBONG, of legal age, Filipino,
ingle an! a "ei!en# of Bl$ %,
Lo# %&, 'e(a Hoe, P*ae %, Talia+ Ci#+, af#e" *aing een !l+
o"n #o in a((o"!an(e i#*
la, !epoe an! #a#e THAT :
0. La# 1a"(* 23, %204, I a oe*e"e a# Laangon *en I no#i(e! #*a#
+ alle# a
no# in + ag5
%. 1+ alle# (on#ain + 6((e Ca"! of E7L Se"i(e P*il ea"ing no.
892%:, + $e+
fo" pe!e#al ;
