REPUBLIC OF THE PHILIPPINES )

City of Cebu ) S.S

AFFIDAVIT OF LOSS

I, _____________, of legal age, single and residing

at______after having been duly sworn to according to law
hereby depose and state:

1. That I am the owner of a Nokia cellphone model 6150 with

unit number 0917-5555555 under account number 222222;

2. That on the 30th of October, 2002 with a number of books

and packages I was carrying while getting out of my car,
my said cellphone must have slipped from my pocket
because after I reached my office, I hurriedly tried to
get my said cellphone from my pocket but I was a little
bit shocked as it was not there anymore;

3. That after diligent search inside my car and the stairs

and elevator used going up my office, my said cellphone
was nowhere to be found anymore;

4. That I am executing this affidavit in order to attest to

the truth of the foregoing circumstances and for the
purpose of reporting the loss to the Globe business
center.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of

October, 2002 at the City of Manila.

Signature of Affiant