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REPUBLIC OF THE PHILIPPINES

) S.S.
CITY OF MEYCAUAYAN

AFFIDAVIT OF LOSS
I GERARDO P. NATANGCOP, of legal age, married, and with a residence
at 634, 26th Street, Phase 5-C, Las Villas de Sto. Nino, Bagbaguin,
Meycauayan City, after having been duly sworn to in accordance with law,
do hereby depose and state:
1. That my wife and I purchase some goods at SM Marilao during its
sale last October 2009.
2. That during the sale, I joined the raffle draw at the department store
and was issued a raffle stub.
3. That only today, December 9, 2009 I received a letter from SM
Marilao informing me that I won in the said raffle draw and to claim
the prize I have to bring the raffle stub.
4. That the aforesaid raffle stub was already loss/ cannot be located.
5. That diligent effort exerted to locate the aforesaid raffle stub proved
futile.
6. That I attest to the truth of the foregoing statement.
IN WITNESS WHEREOF, I have hereunto affixes my signature this 9th
day of December 2009.
___________________________
Affiant
SUBSCRIBED AND SWORN to before me this _______ day of
December 2009. Affiant exhibiting to me his/her Community Tax
Certificate No. ____________ issued on ________________ at
__________..

ADMINISTERING OFFICER

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