Republic of the Philippines)S.S.

City of Quezon City

)

AFFIDAVIT OF LOSS

I, , Filipino, of legal age, single, and a resident , after being duly sworn to in accordance
with law, hereby depose and state:

1. That I am a subscriber of Globe Telecom and the owner of prepaid mobile number

2. That on (insert date) at around (insert time) p.m., while I was riding a, I lost my
mobile phone which I usually place in my back pocket; (change facts)

3. That inside the said mobile phone is my SIM card from Globe Telecom with the
mobile number stated above;

4. That despite diligent search and efforts to locate the my mobile phone wherein the
said SIM card was installed, I could not find them such that I now believe that
they are now lost beyond recovery.

As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and to
support my application with Globe Telecom for the issuance of a new SIM card bearing the same
mobile number as replacement for my lost SIM card.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at Quezon

City, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me, this ___ day of ___________, by Mel John
S. Yambao who exhibited to me his Drivers License ID No. (insert id no.) issued at East Avenue
Quezon City on (insert date) and expires on (insert date).
Doc. No. _______;
Page No. _______;
Book No. _______;
Series of 2016.