AFFIDAVIT OF LOSS

I, _____________, single, Filipino, of legal age, with postal address at

__________________________, after having been sworn to in accordance with law
hereby depose and state that:

1. THAT, I am the lawful and registered owner of SIM CARD issued by GLOBE
TELECOM, with Account Number _______________.

2. THAT, sometime on ___________, somewhere in ______________, while I was

on my way to work, my cellular phone was lost.

3. THAT, I only learned with the said lost when I was about to get it in my pocket to
call my officemate to say that I will be late. It may have been slipped out of my
pocket.

4. THAT, in my said cellular phone, it is where my said sim card is inserted.

5. THAT, I tried my best to locate the same but my effort turned futile as the same
can no longer be located.

6. THAT, I am issuing this Affidavit for the purpose of having my cellular number
retained since all contact numbers of my family, relatives, friends, officemates
were saved in said sim card. And for the purpose of having it reported to
___________________.

In witness whereof, I have hereunto set my signature this ____, day of ___________,
2023 hereat _____________, Philippines.

__________________
Affiant

SUBSCRIBE AND SWORN TO before me this _____, day of __________, 2023. Affiant
exhibited to me his __________________, a proof of his identity.

NOTARY PUBLIC
Doc. N0. ____
Book N0. ____
Page N0. ____
Series of 2023