Republic of the Philippines )

____________,_____________ ) S.S.

AFFIDAVIT OF LOSS
KNOW ALL MEN BY THESE PRESENTS:

I, Agnes P. Vittali of legal age, Filipino, single,, and a resident of Makati City, Philippines , after having
been sworn in accordance with law, hereby deposes and states the following:

1. I am holder/owner/ or possessor of the following item:

 Globe Sim Card bearing the number of +63 906 247 3630

2. I have recently discovered the said item is irretrievably lost and can no longer be found despite
diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

___________________________
Affiant

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below. The affiant
exhibited to me his competent evidence of identity as indicated above.
Signed this ______________at ________________, ______________________, Philippines. WITNESS
MY HAND AND SEAL.

Notary Public

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