REPUBLIC OF THE PHILIPPINES)

CITY OF PARAÑAQUE ) S.S.

AFFIDAVIT OF LOSS
I, ROSELLE E. KAHIWAT, of legal age, single, Filipino Citizen, and with residence and postal
address at 112 Teacher Bliss, Brgy. 201, Kalayaan, Pasay City, after having been sworn to in
accordance with law, do hereby depose and state:

1. That I am the owner/possessor of a Globe Telecom SIM Card with No. 0917-850-9416,
whereas also used in my old GCash Account;

2. However, on February 24, 2023 (Friday), I noticed that the said phone was missing inside my
bag, presumably, dropped or pickpocketed by some unidentified person along Bicutan
footbridge without me noticing it;

3. That efforts were exerted to obtain the said SIM Card, however, in spite of diligent ways, it is
now beyond recovery;

4. That I am executing this affidavit to inform those concerned about the loss of the
aforementioned SIM Card;

5. Finally, I am executing this affidavit to attest to the truth of the facts stated above, for
reissuance of the said SIM Card, in lieu of the one’s that was lost and for transferring the
balance of the said GCash Account to another account and for whatever legal purposes this
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of March, 2023 in the City
of Parañaque, Philippines.

MARK ANGELO S. ABOT

Affiant

SUBSCRIBED AND SWORN to before me, this 1st day of March, 2023 in Parañaque City,
Philippines. Affiant exhibited to me his: PhilHealth Card – 01-026164048-7.

Notary Public

Doc No. _______

Page No. _______
Book No. _______
Series of 2023.