Republic of the Philippines)

City of Zamboanga )s.s.

X------------------------------------X

AFFIDAVIT OF LOSS

I, HAZEL LUDDIE F. CHIONG, of legal age, married, Filipino and a resident of

Green Valley Subd., Doña Nene Dr., Gov. Ramos Avenue, Sta. Maria, Zamboanga City,
Philippines, after having been duly sworn to in accordance with law, depose and say,
that:

1. I am the holder of a Globe Touch Mobile (TM) SIM card with the numbers
+63906-7554870;

2. That on December 4, 2019 at on or about 8:00 o’clock in the evening, I

discovered that my cellular phone where said SIM Card was inserted was
missing;

3. I tried to look for the said cellular phone and SIM Card in some other places
where I might have left them, but all my efforts proved futile that for all
intents and purposes, I am now declaring the Globe TM Sim Card with the
numbers +63906-7554870 lost and beyond recovery;

4. I execute this Affidavit to attest to the truth of the foregoing facts based on
personal knowledge and authentic records for whatever legal purpose it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this 12 th day of

December 2019 at Zamboanga City, Philippines.

HAZEL LUDDIE F. CHIONG

Affiant

SUBSCRIBED AND SWORN to before me on this 12th day of December 2019

at Zamboanga City, Philippines, Affiant being personally known to the undersigned
notary public.

Doc. No.
Page No.
Book No.
Series of 2019