REPUBLIC OF THE PHILIPPINES ) S.S.

AFFIDAVIT OF LOSS

I, CARL RENZO C. CHAN, of legal age, with address at Unit 3817, Princeton
Residences, Aurora Boulevard, 1112 Quezon City, after being sworn to in accordance with law,
depose and state:

1. On September 27, 2023 in the evening, I took a taxi from Robinsons Magnolia
going to Princeton Residences. When I arrived, I paid the fare and got off the taxi.

2. After, I realized that I left my Redmi Note 10 cellular phone with sim card nos.
09277703021 and 09938640701 in the taxi.

3. I exerted all efforts to get the details and whereabouts of the taxi I rode but to
avail.

4. I execute this affidavit to attest to the truthfulness of the foregoing information,

and to secure a replacement sim card from my telecommunications provider and for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _________, 2023 at ______

______________________________
CARL RENZO C. CHAN

SUBSCRIBED AND SWORN to before me, this __________, 2023 at _______,

Philippines. Affiant exhibited to me his ______________.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my Notarial Seal on
the date and place first written above.

Doc. No. ___;

Page No.___;
Book No.___;
Series of 2023.