REPUBLIC OF THE PHILIPPINES)

_______________________________

AFFIDAVIT OF LOSS

I, XXXX, of legal age, single, Filipino, and with residence at

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

1. I am a Touch Mobile subscriber with card number

_____________________;
2. Sometime in June 28, 2019, I was on board in a Van on my way to
Zambales. When upon reaching my destination, I discovered that the
said SIM card which I inserted at the casing of my phone is already
missing which most probably fell off.
3. I exerted due diligence to locate the same but all proved futile as the
same could no longer be located;
4. I am executing this affidavit to attest to the truth of all the foregoing
statements and for purposes of attesting to the circumstances
surrounding the loss of my TM sim card with number
_________________for purposes of securing a replacement for the
same and for all legal intents and purposes this may serve.

IN TRUTH WHEREOF, I have hereunto affixed my signature this

_______________ at ___________________.

XXX
Affiant
ID No. XXX
Issued by: XXX

SUBSCRIBED AND SWORN TO before me this _____________________

at ____________________, affiant exhibiting to me her competent evidence
of identity.

Doc. No. _______

Page No. _______
Book No. _______
Series of 2019.