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REPUBLIC OF THE PHILIPPINES)

CITY OF ________ )SS.


X-----------------------X

AFFIDAVIT OF OWNERSHIP WITH UNDERTAKING

I, JUAN DE LA CRUZ, of legal age, Filipino, single and a resident of Pasig City, Philippines after
having been duly sworn to in accordance with law hereby depose and say that:

1. I am the absolute and legal owner of a GSM handset described as follows:

Example:
Make/Model: NOKIA 6630 A. Grey
International Mobile Equipment Identification (IMEI): 354350003717668l

2. On November 21, 2005, I executed an Affidavit of Ownership and Loss with Undertaking and filed the
same with the National Telecommunication Commission to authorize said commission and all
CMTS to block the said GSM handset for the reason that said cellphone was stolen from me by
unidentified person/s;

3. However, on January 9, 2006, I was able to retrieve said GSM handset through a common friend;

4. I hereby request/authorize the National Telecommunication Commission and all CMTS carriers to
unblock the said GSM Handset;

5. 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 or any party may institute by reason
of NTC’s action to unblock the afore-mentioned unit;

6. In support of this request and as proof of my ownership of said cellphone unit, I attached hereto a
photocopy of the following documents:

A. Social Security System Identification Card Number ________


B. Professional Driver’s License No. ___________
C. Employment Identification Card
D. Police Report

7. I am executing this affidavit to attest to the truth of the foregoing facts .

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of January 2006 at Pasig City,
Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this January 13, 2006 at Pasig City, Philippines, affiant
exhibited to me his Community Tax Certificate No. 1111111 issued at Pasig City on January 13,2006 .

Doc. No. ________;


Page No. ________;
Book No. _______ ;

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