Republic of the Philippines)

City of Dumaguete ) S.S

Province of Negros Oriental

AFFIDAVIT OF LOSS

I, JERAN E. GREJALDO., of legal age, married, a resident of Daro, Dumaguuete City,

Negros Oriental, after having sworn to in accordance with law, depose and say;

1. That I am a holder of a Sun Cellular Sim Card with mobile number 09228460265
2. That the said Sun Sim Card were lost in my possession on November 5, 2019 while I was
travelling from Valencia to Dumaguete City;
3. That the above-said CELL PHONE and SUN CELLULAR SIM CARD were contained
inside my cell phone sling pouch and the latter might have fallen off my bag without my
knowledge;
4. That earnest efforts were made up to present but proved futile, thus, I now believed that the
CELL PHONE and SUN CELLULAR SIMCARD are now beyond recovery;
5. That the said CELL PHONE and SUN CELLULAR SIMCARD were not confiscated
by the authorities for any violation of law, or used for any illegal purpose but was lost under
the circumstances hereinabove-stated: and
6. That I am executing this affidavit in good faith and not for the purpose of fraud but solely to
prove the fact of loss, to attest to the foregoing fact and for whatever legal purpose this may
serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this __ day of 20__ in

_________ Philippines.

JERAN E. GREJALDO
Affiant
COMPANY ID No. : 4409-3782

Republic of the Philippines )

City of Dumaguete) S.S.

SUBSCRIBED AND SWORN TO before me this ___ day of __________ in the City of
Dumaguete, Negros Oriental, Philippines.

Doc. No.
Page No.
Book No.
Series of 2019.