Republic of the Philippines)

Tuguegarao City, Cagayan ) S.S

AFFIDAVIT OF LOSS

That I, PRINCESS M. TEMPLO of legal age, Filipino, single and a resident of

Nassiping Gattaran, Cagayan after having sworn to in accordance by law do hereby depose and
say;

1. That I am a Globe subscriber with SIM Card Number 09679902584;

2. That said SIM Card Number 09679902584is lost as the same might have fallen off from
my pouch nor misplaced along with my personal files;

3. That despite assiduous efforts to locate said SIM Card Number 09679902584, the same
prove futile;

4. That I am executing this affidavit in good faith and attaching my two-government issued
valid identifications- Philippine National ID and University Student ID;

IN WITNESS HEREOF, I hereby unto set my hand this 22 nd day of May 2023 in
Tuguegarao City, Cagayan.

PRINCESS M. TEMPLO
Affiant
PNID No. 3520-6849-3263-8146
CSU ID No. 19-02368

SUBSCRIBED and SWORN to before me this _____ day of ______________ in

Tuguegarao City, Cagayan.

Doc No.
Page No.
Book No.
Series of 2023