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    Affidavit of Ownership and Loss With Undertaking

    Uploaded by

    John Vincent Pineda Valdez
    1. The affidavit is a request to block a lost/stolen mobile phone and SIM card from further use. 2. It provides details of the lost phone including make, model, IMEI number and SIM card number. 3. The affidavit undertakes that the telecom carriers will not be held liable for blocking the devices and includes proof of ownership documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Affidavit of Ownership and Loss With Undertaking

    Uploaded by

    John Vincent Pineda Valdez
    502 views1 page
    1. The affidavit is a request to block a lost/stolen mobile phone and SIM card from further use. 2. It provides details of the lost phone including make, model, IMEI number and SIM card number. 3. The affidavit undertakes that the telecom carriers will not be held liable for blocking the devices and includes proof of ownership documents.

    Original Description:

    affidavit of loss NTC

    Original Title

    Affidavit.pdf

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    1. The affidavit is a request to block a lost/stolen mobile phone and SIM card from further use. 2. It provides details of the lost phone including make, model, IMEI number and SIM card number. 3. The affidavit undertakes that the telecom carriers will not be held liable for blocking the devices and includes proof of ownership documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    502 views1 page

    Affidavit of Ownership and Loss With Undertaking

    Uploaded by

    John Vincent Pineda Valdez
    1. The affidavit is a request to block a lost/stolen mobile phone and SIM card from further use. 2. It provides details of the lost phone including make, model, IMEI number and SIM card number. 3. The affidavit undertakes that the telecom carriers will not be held liable for blocking the devices and includes proof of ownership documents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    REPUBLIC OF THE PHILIPPINES] S.S.

    QUEZON CITY ]

    AFFIDAVIT OF OWNERSHIP AND LOSS WITH UNDERTAKING

    I, _________________________________________ of legal age, Filipino citizen and a resident of


    ________________________________________________________________________ with telephone
    number_________________ and with office address at ___________________________________________
    and office number ______________________ after being sworn in accordance with law do hereby depose and
    say:

    1. That I am requesting all CMTS carriers to block the GSM handset that was lost/stolen in my possession by an
    unidentified person/s as owner thereof with particulars as follows:

    Make / Model / Type International Mobile Equipment Identification (IMEI)

    2. That I am also requesting ______________________________ to block the Subscriber Identity Module (SIM)
    card/cell phone number contained in the lost/stolen cell phone mentioned above;

    0 9
    0 9

    3. That I hereby undertake to hold free from any responsibility or shall not hold NTC and the above-mentioned
    carriers liable for whatever claims, loss or damages that any party may institute by reason of NTC’s action to
    permanently block the aforementioned unit from usage;

    4. That in support of this request and as proof of my ownership of said cell phone unit, I attached hereto the
    following documents, after making the original available for comparison;

    Any one (1) of the following: OR Any two (2) of the following:
    Photocopy of passport Photocopy of company ID/school ID
    Photocopy of driver’s license Photocopy of TIN/SSS/GSIS ID
    Photocopy of postal ID Other Government issued ID ________________

    Proof of ownership: receipt of purchase owner’s certificate barcode/sticker from the box
    In the absence of any proof of ownership: Police Report Others / Pls. specify _______________

    Additional Information: Sex: M F


    ___ Lost / Misplaced Age: below 18 18-29 30-39
    ___ Stolen (Theft / Robbery / Hold-up) 40-49 50-59 60 above

    Place of incident: _________________________________


    Date : _________________________________ Nighttime Daytime

    5. That I am executing this affidavit of ownership and loss with undertaking to attest to the veracity and truthfulness
    of the foregoing declaration and to be used for whatever legal intent and purposes the same may thus serve.

    FURTHER AFFIANT SAYETH NONE.


    ___________________________________
    AFFIANT
    Signature Over printed name

    SUBSCRIBED AND SWORN TO BEFORE ME on this ____ day of _______________ 20__, affiant
    has exhibited to me his/her Community Tax Certificate No. ___________________ issued on
    _______________________ at ________________________.

    ADMINISTERING OFFICER

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