REPUBLIC OF THE PHILIPPINES } S.

S
LIPA CITY, BATANGAS }

AFFIDAVIT OF LOSS
I, ______________________, of legal age, Filipino,
single, and with residence address at Lipa Royale Estate,
Inosloban, Lipa City, Batangas after having duly sworn to in
accordance with law, depose and state that:
1. I am a Globe Telecom Postpaid subscriber having
been issued by Globe Telecom a SIM Card with a designated
mobile phone number that of _________________;

2. I remember putting the said Sim Card at the back

of my phone for safekeeping;

3. However, when I decided to insert the said Sim

Card on my other phone, it was no longer in the place where
I put it;

4. I took effort to locate the same but my search

proved to be futile;

5. I am executing this affidavit to attest the

veracity of my foregoing statements and for whatever legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affix my signature

this 17 March 2021 here at Lipa City, Batangas.

_________________________
Affiant

SUBSCRIBED AND SWORN to me this 17 March 2021 here at

Lipa City, Batangas affiant exhibiting to me his Driver’s
License with No. ________________ bearing his photograph and
signature as his competent proof of identification.
WITNESS MY HAND AND SEAL on the date and place first
mentioned above.
Doc. No. 74
Page No. 15
Book No. LXXIV
Series of 2021.