Republic of the Philippines)

City of Tagbilaran           ) S.S.

AFFIDAVIT OF LOSS

I, JOVIE GENIO RAMO, Filipino, of legal age, married, and with

residence at Brgy. San Roque, Baclayon, Bohol, Philippines, after being
duly sworn to in accordance with law, do hereby depose and state:

1. That I am a holder of a sim card, (talk n text), 0907-8532-

707;

2. That on or about November 30, 2019, the sim was lost and
its whereabouts cannot be ascertained despite due and
diligent search made and undertaken such that I now
believe that the same is lost beyond recovery;

3. That I now request the Smart Communication to issue a

new sim card in lieu of the lost one but with the same
number and I bind myself to surrender the lost sim card in
the event that the same is found and/or located;

4. That I covenant to indemnify the Smart Communication for

any loss and damage it may incur by reason of its issuance
or replacement;

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

of the above-stated facts, for the purpose of the issuance
of a new sim card or any other legal purpose which this
affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

December 19, 2019 at Tagbilaran City, Philippines.

JOVIE GENIO RAMO

Affiant
TIN: 460-715-644-00
Issued by BIR

SUBSCRIBED AND SWORN TO BEFORE ME this December 19,

2019 affiant personally presented to me her TIN, as competent and
valid proof of his identity.

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2019