Republic of the Philippines)

Quezon City ) S.S

AFFIDAVIT OF LOSS

I, SANDY BELMONTE ABIAD, of legal age, single, Filipino Citizen and a resident of 03
BUTUAN ST. PAEL SUBD. CULIAT QUEZON CITY, after having been duly sworn to in
accordance with law, hereby depose and say:

1. That I am a prepaid subscriber/customer of Smart Communications, Inc. and was issued

with a SIM card with Mobile No. 09207363491;

2. That on May 6, 2023, around 5:40 PM at MRT Magallanes Station, the said SIM card
was lost;

3. That despite diligent efforts to locate the said item, it could no longer be found or
recovered;

4. That I am executing this affidavit to attest to the veracity of my statements and to support
the application for replacement of the said item and for whatever legal purpose it may
serve;

IN WITNESS WHEREOF, I hereunto affix my signature this May 09th, 2023 at Quezon City.

SANDY BELMONTE ABIAD

Affiant

SUBSCRIBED AND SWORN to before me this May 09th, 2023, at Quezon City;

Doc No. ________;

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