REPUBLIC OF THE PHILIPPINES )

CITY
OF
MANILA
)SS.
X-----------------------------------------X
AFFIDAVIT OF LOSS
I, Marife S. dela Cruz, Filipino, of legal age, single and a resident of
669 Bambang Dulo Bocaue Bulacan Philippines, after having duly sworn to in
accordance with law, hereby depose and say that:
1.

I am the holder of a Subscriber Identity Module (SIM) Card Number

09151296772 issued by Globe Telecom;

2.

I lost said SIM card on April 19, 2016 and that I exerted all
efforts to locate the same but I could not remember exactly where I
placed/left it and it is considered lost for all legal purposes;

3.

Said SIM Card was not confiscated by any officer of the law by
reason of any violation of any law, ordinance, presidential decree or
rules and regulation of anything; and neither was it offered as
collateral for any loan;

4.

I am executing this affidavit to attest to the foregoing facts;

IN WITNESS WHEREOF, I have hereunto set

______________ in the City of ___________, Philippines.

my

hand

this

Marife S. dela Cruz

Affiant
SUBSCRIBED AND SWORN to before me this _______________ in the
City of ____________ Philippines, affiant having exhibited to me
her community tax certificate with no. _______________ issued on
______________ at _____________.
Doc. No.____;
Page No.____;
Book No.____;
Series of 2016.