REPUBLIC OF THE PHILIPPINES)

CITY OF LUCENA ) SS.

x----------------------------------------------------x

AFFIDAVIT OF LOSS

I, VER D. MACALALAD, of legal age, Filipino, single, and a resident of Purok

Silverado, Brgy. Dalahican, Lucena City, Quezon, Philippines, after having been duly
sworn in accordance with law, hereby depose and state:

1. That I am a regular subscriber / user of a Smart Mobile SIM Card with No.
09685959457;

2. That in the afternoon of January 12, 2023, I forgot my Realme 9 Pro cellular

phone with the said SIM Card in my friend’s house which I visited;

3. That when I returned to the living room of the said house at around 10 am, from
the room in the second floor, I discovered that my cellular phone was missing
together with my said Mobile SIM Card which I placed in the dining table as far
as I can remember;

4. That despite diligent search and efforts to locate said cellular phone, I could not
find the same such that I now believe that said is now lost beyond recovery
together with the aforesaid SIM Card;

5. That in view thereof, I now desire and hereby request SMART Communications
to issue another SIM Card in lieu of the lost one;

6. That I executed this affidavit in order to attest to the truth of the foregoing and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 14 th day of January

2023 at Lucena City, Philippines.

VER D. MACALALAD
Affiant
P0279259C

SUBSCRIBED AND SWORN to before me, this 14th day of January 2023 at
Lucena City, Philippines.

ATTY. CHRISTOPHER P. JUNIAR

Notary Public
Attorney’s Roll No. 77224
PTR No. 3416706 01/03/2023 Lucena City
IBP O.R. No. 256546 12/31/2022 Pasig City
Tax Identification No. 277-604-758
MCLE exempted, pursuant to
MCLE Governing Board Order No. 1, s, 2008