REPUBLIC OF THE PHILIPPINES )

___________________________ ) S.S.

AFFIDAVIT OF LOSS

I, _____________________________ , of legal age, married, Filipino, and a

resident of _____________________________________________, after having been
duly sworn to in accordance with law, depose and state THAT:

1. Pursuant to the Implementing Rules and Regulations (IRR) of Republic Act No.
11934 otherwise known as “SIM Registration Act”, I hereby provide the following
personal information to fully establish my ownership of a lost TNT SIM CARD:

Name: _____________________________________________
Address: _____________________________________________
Date of Birth: _____________________________________________
Sex: _____________________________________________
Mobile Number: ____________________________________________
Other information: __________________________________________

2. Sometime on ____________________, said TNT Sim Card was lost together

with my cellular phone;

3. Efforts were exerted to locate and recover said TNT Sim Card, but inspite of
diligent search and effort, it could not be found and the same is now beyond
recovery;

4. I am executing this Affidavit of Loss to attest to the truth of the foregoing and to
support my application for the issuance of a new TNT Sim Card with number
_______________________ , in lieu of the one that was lost.

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

___________________ in, _______________________, Metro Manila,
Philippines.

__________________
AFFIANT

SUBSCRIBED AND SWORN to before me, this day of _______________ in

_______________ City, by the affiant who has exhibited to me his/her
__________________________ with No. _______________________ as competent
proof of his/her identity.

WITNESS MY HAND AND SEAL

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 202__.