REPUBLIC OF THE PHILIPPINES)
) SS.
DONE: IN THE CITY OF BAGUIO )
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AFFIDAVIT OF LOSS
I, MILA BOLOICO MENDOZA, of legal age, Filipino, married, a resident of No.
159 Idogan Village, San Carlos Heights, Baguio City, after having been duly sworn to in
accordance with law, hereby depose and state:
1. That I am a co-owner with my husband of a duly registered Toyota Fortuner,
white in color, model 2007 with Plate No. AHJ 373;
2. That on December 22, 2013 at about 1:30 p.m., I parked my said motor
vehicle in front of the Baguio Convention Center;
3. On the same date at around 5:00 pm, my daughter, Kyreen Louise Mendoza
went to get my said motor vehicle and parked it at SM Baguio. However,
when my daughter was about to park my said motor vehicle, the guard on
duty of SM Baguio informed my daughter that my said motor vehicle had no
spare tire;;
4. That around 8:00pm on the same date, when I checked my vehicle while at
home, I noticed that the spare tire of my said motor vehicle was missing;
5. That upon notice of said loss, I surmised that the spare tire of my motor
vehicle was stolen when I parked the same in front of the Baguio Convention
Center;
6. That said spare tire of my said motor vehicle is now beyond recovery, hence,
considered lost;
7. That I reported the above-narrated incident to the Philippine National Police
Police Station 5 of Baguio City;
That I am executing Affidavit to attest to the truthfulness of the foregoing and for
all legal intents and purposes.
IN WITNESS WHEREOF, I have hereunto set my hand this 7 th day of January 2014,
in the City of Baguio, Philippines.
MILA BOLOICO MENDOZA
Affiant
Non-Professional Driver’s License No. A01-02-082458
Valid Until May 24, 2016
SUBSCRIBED AND SWORN TO before me this 7th day of January 2014, in the
City of Baguio, Philippines. Affiant having exhibited to me her Driver’s License bearing
no. appearing below her name above.