REPUBLIC OF THE PHILIPPINES

CITY OF CABANATUAN )S.S.

X---------------------------X

AFFIDAVIT OF LOSS

I, ANGELICA GARCIA DALUSONG, of legal age, single, Filipino and a

resident of Brgy. Kawayan Bugtong, Guimba, Nueva Ecija, after having been duly
sworn to in accordance with law hereby depose and say:

1. That I am the owner of two (2) Globe SIM Card with No.
09159712803 (Prepaid) and a Cellular Phone with No.
09274031211 (Postpaid);

2. That the SIM card No. 09159712803 was lost/misplaced;

3. That on November 30, 2017 around 10:00 in the morning I

went to Guimba Public Market to buy some foods, when I got
home I discovered that my cellphone is missing;

4. That despite diligent search to locate said cellphone and two (2)
SIM cards same could no longer be found hence it was deemed
lost;

5. That I am executing this affidavit to attest to the truth of all the

foregoing and for the purpose of informing the concerned
authorities about this fact and for whatever legal intents the
same may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of

January 2018, here at Cabanatuan City.

ANGELICA G. DALUSONG
Affiant

SUBSCRIBED AND SWORN to before me this 4th day of January 2018,

here at Cabanatuan City.

Doc. No.______
Page No.______
Book No._____
Series of 2018.