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Affidavit of Loss

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REPUBLIC OF THE PHILIPPINES )

CITY OF MANILA )SS.


X-----------------------------------------X
AFFIDAVIT OF LOSS
I, Jasmin S. Borromeo, Filipino, of legal age, single and a residentof Teresa,
Rizal, Philippines, after having duly sworn to in accordance with law, hereby
depose and say that:
1.
I am the holder of a Prepaid Subscriber Identity Modeule (SIM) Card
Number +639354513277 issued by Globe Telecom;
2.
I lost said SIM card on or before October 2016 and that I exerted all
efforts to locate the same but I could not remember exactly where I placed/left
it and it is considered lost for all legal purposes;
3.
The said sim number was either deactivated or not before the incident
has happened.
4.
The number was used for Password Recovery for mails, itinerary receipt
and other important documents and mail named on my account.
5.
Said SIM Card was not confiscated by any officer of the law byreason of
any violation of any law, ordinance, presidential decree orrules and regulation
of anything; and neither was it offered ascollateral for any loan;
4. I am executing this affidavit to attest to the foregoing facts;
IN WITNESS WHEREOF, I have hereunto set my hand this ______________ in the City of
___________, Philippines.
Jasmin S. Borromeo
Affiant
SUBSCRIBED AND SWORN to before me this _______________ in the City of
____________ Philippines, affiant having exhibited to me (his or her) community
tax certificate with no. _______________ issued on ______________ at _____________.
Doc. No.____;
Page No.____;
Book No.____;
Series of ____.

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