REPUBLIC OF THE PHILIPPINES )

CITY OF MUNTINLUPA ) SS.

AFFIDAVIT OF LOSS

I, YURI S. CASILAN, of legal age, Filipinos with residence and postal address
at 735-B40 L12 Nicolasa Virata, G.M.A Cavite, after having been duly sworn to in
accordance with law, do hereby depose and say that:

1. I am a holder of a SIM CARD with No.09266639672 issued by GLOBE

TELECOM.;
2. The said SIM CARD was lost on December 27, 2019 in the vicinity of GMA
Cavite;
3. Despite diligent effort to locate the said SIM CARD yielded negative result;
4. I execute this instrument in order to attest the truth of the above facts, and for all
the legal intents and purposes this may serve.

AFFIANT FURTHER SAYETH NAUGHT

YURI S. CASILAN
Affiant

SUBSCRIBED AND SWORN to before me this 2nd day of January, 2020 in the
City of Muntinlupa Affiant exhibited to me his Competent Evident of Identity No.
______________________issued by ________________________.

Doc. No. ________;

Page No. ________;
Book No. ________;
Series of 2020.