REPUBLIC OF THE PHILIPPINES ) CITY OF MANILA ) S.

S
AFFIDAVIT OF LOSS

I, Kristofer Martin R. Pillarina, of legal age, single, and residing at Antipolo City,
Rizal, after having been duly sworn to according to law hereby depose and state:

1. That I am the owner of a DITO SIM CARD __________ with unit

number _____________________under account number
_____________________;

2. That on the tenth (10th) day of October, 2023 with a number of

_____________ I was carrying while getting out of my car, my said
____________ must have slipped from my pocket because after I
reached my office, I hurriedly tried to get my said ______________
from my pocket but I was a little bit shocked as it was not there anymore;

3. That after diligent search inside my car and the stairs and elevator used
going up my office, my said ____________ was nowhere to be found
anymore;

4. That I am executing this affidavit in order to attest to the truth of the

foregoing circumstances and for the purpose of reporting the loss to the
Globe business center.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of

_______, 2013 at the City of ____________.

__________________ _________________
Affiant Affiant

SUBSCRIBED AND SWORN to before me this __ day of ___________ 2013,

affiant exhibited a competent proof of their Identity:
__________________
__________________
Doc. No. __________; Page No. __________; Book No. __________;
Series of 2013.
Govt. Issued I.D.
_______________________
_______________________
Notary Public
Valid Until
________________
________________