AFFIDAVIT OF LOSS

I, HENRY PROSPERO LEPITEN, JR., Filipino citizen, of legal age and resident of Bogo
City, Cebu, Philippines, after having been duly sworn to in accordance with law, do hereby
depose and say:

1. That I am a post-paid subscriber of GLOBE Telecom, Inc., with Account No.

66015032 and as such, I was issued a SIM Card No. 0917-3057973;

2. That said SIM card was left unnoticed inside our store located in Bogo City, Cebu
and the same could no longer be found.

3. That diligent efforts to recover the same was immediately undertaken, but the same
did not give any positive result.

4. That I am executing this affidavit of loss in order to attest to the veracity and
truthfulness of the foregoing statements and to support my application for the
issuance of a new SIM-card from GLOBE Telecom.

IN WITNESS WHEREOF, I hereunto affixed my signature this 27 th day of April 2018, in

San Remigio, Cebu, Philippines.

________________________________
HENRY PROSPERO LEPITEN, JR.
(Affiant)

SUBSCRIBED AND SWORN TO, before me on the same date and place first above-
mentioned.

DOC No. _____;

PAGE No. _____;
BOOK No. _____;
SERIES FO 2018