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