REPUBLIC OF THE PHILIPPINES)

BACOLOD, LANAO DEL NORTE) S.S.

AFFIDAVIT OF LOSS

I, GLENNY LAPATIS, of legal age, Filipino citizen, married and

residing at Zone 5, Binuni, Bacolod, Lanao del Norte after having been
sworn in accordance with law hereby depose and state:

I am a holder and in possession of a phone particularly described

as Iphone 6, rose gold with blue casing, with sim card no.
09977460669 (G-cash);

That while travelling to Maranding, Lala, Lanao del Norte on

October 24, 2020 at around 6:30 in the evening, I noticed that the
phone inside my bag was already missing;

Efforts were exerted to locate said phone, but in spite of diligent

search, it could not be found and the same is now beyond recovery;

That I am executing this affidavit to attest to the truth of the

foregoing and for the purpose of securing another sim card with
Globe Telecom.

Affiant Further Sayeth Naught

IN WITNESS WHEREOF, I have hereunto set my hand this 26th day

of October 2020, at Bacolod, Lanao del Norte.

GLENNY LAPATIS
Affiant

SUBSCRIBED AND SWORN TO before me, this 26th day of October

2020, at Bacolod, Lanao del Norte.

ATTY. ALFONS JANSSEN P. MARCERA

Notary Public
Serial No. 19-229
Iligan City- Lanao del Norte
Until December 31, 2020
Doc. No. : ___; IBP Lifetime No. 01840
Page No. : ___; Roll No. 70427- July 31, 2017
Book No. : XI; PTR No. 4321588- January 2, 2020
MCLE Compliance No.VI- 0022669- 8-18-18
Series of 2020.