Republic of the Philippines )

City of Ormoc )S.S.

AFFIDAVIT OF LOSS

I, MANILYN A. CAGABHION, of legal age, Filipino, married

and a resident of Sitio Lower, Brgy. Mabato, Ormoc City, Leyte,
Philippines, after being duly sworn in accordance with law, depose and state:

1. That I was in possession of prepaid Globe Sim Card No.

09177418747;

2. That the said SIM card was lost due to inadvertence and without fault
on my part and the same was not seized or confiscated from me;

3. That despite diligent search and efforts to locate said SIM card, I

could not find the same such that I now believe that said SIM card is
now lost beyond recovery;

4. That I execute this affidavit to attest to the truth of the foregoing and
for whatever purpose this affidavit may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this _ day

of ____, 2023 in Ormoc City, Leyte, Philippines.
 
MANILYN A. CAGABHION
Affiant
National ID no. 3501-7805-2892-4719

SUBCRIBED AND SWORN TO before me this _ day of _____,

2023in Ormoc City, Philippines, affiant exhibited to me his valid proof of
identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2023