Republic of the Philippines)

Province of Southern Leyte.) S. S.

City of Maasin…..............)

AFFIDAVIT OF LOSS

I, BARYEN S. SALVA, Filipino, single, of legal age and a resident of, Maasin
City, Southern Leyte, Philippines, after having been duly sworn to in accordance
with law, do hereby depose and say:

1. That I am a plan holder of Globe Telecom, Inc., with office address located
at Maasin City, Southern Leyte;

2. That relative thereto, a GLOBE SIMCARD No. 09175569926 was issued in

my favor;

3. That undesirably however, my cell phone, together with the aforesaid

Simcard was stolen from my bag last January 2018;

4. That I have exerted my best efforts to locate and recover the aforesaid
Simcard, but my efforts proved futile. I now consider the same
irretrievably lost;

5. That I am executing this affidavit to attest the veracity of the foregoing,

and for the purpose of requesting for another sim card, bearing the same
number.

IN WITNESS WHEREOF, I have hereunto set/affixed my signature this

________________ at Maasin City, Southern Leyte, Philippines.

BARYEN S. SALVA
Affiant
TIN No. 944-458-285

SUBSCRIBED AND SWORN TO before me this ________________ at Maasin

City, Southern Leyte, Philippines.

Doc. No. ___

Page No. ___
Book No. ___
Series of 2018