REPUBLIC OF THE PHILIPPINES)

SAN JUAN CITY ) S.S.

AFFIDAVIT OF LOSS

I, XXXXXXXXXXXXXX, of legal age, Filipino, single, with address at No. 6-C

Dona Juliana Bldg., Broadway St., Brgy. Valencia, Quezon City, Philippines, after
having been duly sworn to in accordance with law, depose and say that:

1. I am a Globe prepaid subscriber with Subscriber Identification Module

(SIM) number XXXXXXXXXX;

2. On 04 January 2019, I was hailed and boarded a taxi. When we reached

Symphony Tower in Timog, Quezon City, I immediately alighted as I was running late
for a meeting. After some time, I reached for my Nokia cellular phone in my pocket
but found out that it was missing;

3. I tried to call my phone number using a friend’s phone and it was

ringing. After a while, someone picked up the phone and it was the taxi driver,
confirming that I left the phone at his taxi’s backseat.

4. With my pleading, the taxi driver agreed and promised to deliver my

phone at my workplace but he was not picking up the phone anymore when I was
making a follow. I tried to call for several times until my phone number cannot be
reached anymore.

5. I exerted efforts to further locate the said phone, but it could no longer
be found and is now beyond recovery;

6. I am executing this affidavit to attest to the truth of the foregoing and

for the purpose of applying with Globe Telecom so that a replacement Subscriber
Identification Module (SIM) with the same number XXXXXXXXX may be issued in
my favor.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of January

2019, San Juan City, Philippines.

XXXXXXXXXXXXXXXXXXXXX
Affiant

SUBSCRIBED AND SWORN TO before me this this 15th day of January 2019,
San Juan City, Philippines, affiant exhibiting to me his Postal Identity Card No. PAN
xxxxxxxxxxx with validity until xxxxxxxxxxxxxx.

ATTY. ________________________
Notary Public