Republic 

of the Philippines)
Province of South Cotabato) S.S.
City/Municipality of Polomolok)
x------------x

AFFIDAVIT OF LOSS

I, Jayrus D. Legario, Filipino, of legal age and a resident of Narra Street,

Lantana Subdivision, Cannery Site, Polomolok, South Cotabato, Philippines, after
being duly sworn in accordance with law, depose and state:

1. That I am a regular subscriber / user of a Globe Mobile SIM Card with

No.09565610807;

2. That sometime around 8 June 2023, when I arrived at Tupi Road I discovered that
my phone is no longer with me.

3. That I might accidentally dropped my mobile phone while driving motorcycle on my

way home that I placed in my pocket.

4. That despite diligent search and efforts to locate said cellular phone, I could not
find the same such that I now believe that said is now lost beyond recovery together
with the aforesaid SIM Card;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and in support of my request / application for the replacement of the said
SIM Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of June at
Polomolok, South Cotabato, Philippines.

JAYRUS D. LEGARIO
AFFIANT

SUBSCRIBE AND SWORN TO before me, a notary public in this 9th day of
June 2023 by the affiant whom I identified through his Driver’s License ID No. F09-
07-003407.

NOTARY PUBLIC

Doc. No. ____

Page No. ____
Book No. ____
Series of 2023