AFFIDAVIT OF LOSS

I, ABDULLAH M. PANDA, married, Filipino of legal age with postal address at Unit 1 No. 54,
Villarica Road, Santa Rosa 1, Marilao, Bulacan, after having been sworn in accordance with law hereby
depose and state:

1. That I have purchased the sim card no.09153416685 last February 2017.

2. That I usually put the said sim card inside my phone’s case.

3. That the lost sim card was inserted in my phone last December 26, 2022.

4. That despite diligent search and efforts to locate said sim card, I could not find it.

5. That I am executing this affidavit to the truth of the foregoing facts and to request for a
replacement of my sim card.

IN WITNESS WHEREOF, I have hereunto set my hand this ________ day of _____________ at
________________________________, Philippines.

SUBSCRIBED AND SWORN TO before me this ____ day of ___________, affiant exhibited to me
his Passport NO. P3720374B bearing the affiant’s photograph and signature, thru which his identity was
confirmed.

ABDULLAH M. PANDA
Affiant
PASSPORT NO. P3720374B

Doc. No. ____

Page No. ____
Book No. ____
Series of ____