REPUBLIC OF THE PHILIPPINES )

Province of Quezon ) S.S

Lucena City )

AFFIDAVIT OF LOSS
I, NOLANDO CASTRO OCAMPO, of legal age, Filipino, and a resident of Brgy.
Gulang-Gulang, Lucena City, Quezon, after having been sworn to in accordance with law depose
and state:

1. That I own a cellular phone (Samsung) loaded with Globe Sim Card with Mobile No.
0917-130-7733 which is subscribed to GCash and with Globe Postpaid Plan;
2. That on September 23, 2023 while I’m sleeping, a thief entered my house and took
my cellular phone loaded with the aforementioned sim card;

3. That when I awoke from my sleep at around 1:00 a.m., I found out that my cellular
phone which was loaded with the aforementioned sim card was missing;

4. That I immediately reported the incident to the Barangay authorities;

5. That I now consider my sim card lost and beyond recovery for all legal intent and
purposes;

6. That I am executing this affidavit in order to attest to the truth of the foregoing
circumstances and for the purpose of informing the Globe Telecom of such loss and to
secure the replacement of the lost sim card.

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th day of September,

2023 at Lucena City, Quezon.

NOLANDO CASTRO OCAMPO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 25th day of September, 2023 at

Lucena City, Quezon, declarant exhibited to me his Driver’s License No. D07-17-001726.

FRANCIS EDGARDO G. LAVARRO

Doc. No. 191
Notary Public
Page No. 40
Commission Expires: December 31, 2023
Book No. X
Roll of Attorney No. 78537, May 13, 2022
Series of 2023
IBP No. 252794;Dec. 23, 2022, Pasig City
PTR No. 3138402
Jan. 03, 2023, Lopez, Que.