AFFIDAVIT OF LOSS

I, ________________, of legal age, and with address at ___________________, under oath

state:

1. THAT I am a registered owner of _________ Prepaid Sim bearing No. __________;

2. THAT on ____________ I misplaced my sim card;

3. THAT I exerted due diligence and persistent efforts in locating my aforesaid SIM card but
to no avail and I consider the same as lost and can no longer be found;

4. THAT I may request for sim replacement with the same cellular number mentioned above;

5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use the
same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this September 02, 2022 at Davao
City.

________________
Affiant
Valid ID # ______________
Issued ____________

ACKNOWLEDGEMENT

REPUBLIC OF THE PHILIPPINES)

IN THE CITY OF DAVAO . . . . . . . . .) S.S.

BEFORE ME, Notary Public, for and in the City of Davao, Philippines, this _________ day of _________
personally appeared the above-named principal who exhibited before me her competent evidence of identity as
above-stated; known to me and to me known to be the same person who executed the foregoing Affidavit of Loss
and he acknowledged to me that the same is him free and voluntary act and deed.

WITNESS MY HAND AND SEAL on the date and at the place above-written.

Doc. No. ____;

Page No. ____;
Book No.____;
Series of 2022