REPUBLIC OF THE PHILIPPINES)

CITY OF BATANGAS ) S.S.

AFFIDAVIT OF DAMAGED SIM CARD

I, ELUNNA UNTALAN MENDOZA, of legal age, Filipino and resident of Mahacot

Silangan, Batangas City, after having been duly sworn to in accordance with law,
hereby depose and say:

That I am a regular user of a Touch Mobile Subscriber Identity Module (SIM)

Card with No. 0926-972-7695;

That the said Sim Card was damaged because it was not working and cannot be
detected upon injecting on the cellphone;

That I am executing this Affidavit in connection with my application for Visitor

VISA at the Department of Foreign Affairs and/or travel clearance;

IN WITNESS WHEREOF, I have hereunto set my hands this __day of __, 2021 at
Batangas City.

ELUNNA UNTALAN MENDOZA

Affiant
VIN ID No. 1005-0411A-
C0170EUM20000-5

SUBSCRIBED AND SWORN TO before me ___ day of ____, 2021 at Batangas City.

Doc. No. _______ ;

Page No. _______;
Book No. _______;
Series of 2021.