Republic of the Philippines )

City of Iloilo )ss.

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

AFFIDAVIT OF L0SS

I, JEMUEL GERONCA PAGUNTALAN, of legal age, Filipino and a

resident of Brgy. Botongon, Estancia, Iloilo, Philippines, after having duly
sworn in accordance with the law do hereby depose and say;

1. That I am the regular user of a Globe Mobile subscriber identity

(SIM) Card with number 09176052581;

2. On May 21, 2022, I discovered that the said SIM Card was
lost/missing in my possession, either it slipped out or drop
somewhere unnoticed;

3. I failed to recover my SIM Card despite diligent search and

earnest effort to contact and locate said SIM card, and I consider
the same as lost and can no longer be found;

4. I am executing this affidavit to attest to the truth of the foregoing fact

and in support of my application for the replacement of the said SIM
Card and for whatever legal intents and purposes it may serve;

Affiant states nothing further.

IN WITNESS WHEREOF, I had hereunto set my hand this ___ day of

_________________at Iloilo City. Philippines.

JEMUEL GERONCA PAGUNTALAN

(AFFIANT)

SUBSCRIBED AND SWORN TO BEFORE me ___ day of ___________,

2022, at Iloilo City, Philippines. Affiant exhibited her ___________________
Identification Card as herein above indicated.

Doc. No. _____;

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