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City of ________ )

Republic of the Philippines)

AFFIDAVIT OF LOSS

I, ___________________, of legal age, Filipino, and with address


at ____________________________, after having been duly sworn to in
accordance with law, hereby depose and state:

1. That I am a retailer of Smart Communications dispensing


electronic loads (e-load) through my retailer sim no. ____________;

2. That however, sometime on _________________ the said


retailer sim was inadvertently lost in my possession;

3. That I have exerted due diligence and earnest efforts to locate


the said sim, but to no avail;

4. That I execute this Affidavit attest as to the truth of the


foregoing facts and circumstances and for whatever legal purposes it
may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature on


this ____ day of ____________ in the City of __________.

____________________
Affiant

SUBSCRIBED AND SWORN TO before me this ______ day of


_______________ in ___________, affiant exhibiting to me his
competent proof of identity.