Republic of the Philippines )

City of Laoag ) S.S.

AFFIDAVIT OF LOSS

I, MARILOU R. ANDRES, of legal age, married, Filipino, and a resident of

Brgy 15 San Guillermo, Laoag City, Philippines, after having been sworn to in
accordance with, hereby depose and state that:

1. I am a Holder of a Postpaid Plan with Sim Number 09177926585

installed in a SAMSUNG SMART PHONE;

2. I use my phone almost every day and I always keep my said phone in my
pocket

3. Sometime on July 25, 2019 while I am at the wake of my Grandmother in

Brgy Pandan Sarrat, Ilocos Norte, I used the said phone to take pictures
of me and my relatives who are also present in the said wake. When I
went home, I suddenly realized that my phone is no longer with me, we
tried to call my number but the phone was already unreachable;

4. I exerted every effort in locating my phone where my postpaid plan sim

number is installed, but to no avail. Hence, phone where my postpaid plan
sim number is installed is now deemed lost and beyond recovery;

5. My phone where my postpaid plan sim number is installed was never

been confiscated in violation of existing law; and

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

specifically the fact that my phone where my postpaid plan sim
number 09177926585 is installed is now deemed lost and beyond
recovery. This affidavit is also being executed for whatever legal purpose
it may serve.

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

Laoag City, Ilocos Norte.

MARILOU R. ANDRES
Affiant
SUBSCRIBED AND SWORN to before me this __________________ at Laoag
City, Philippines, affiant is personally known to me and attested to me that this
affidavit is his voluntary act and deed

JAY RONALD EMIL JOHN D. LABRADO JR.

NOTARY PUBLIC
until December 31, 2020
Roll No. 68901 - 05/30/2017
IBP No. 067514-01/08/2019
PTR No. 1767145 - 01/03/2019
TIN NO. 270-121-051
MCLE Compliance No VI-0005294
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