AFFIDAVIT OF LOSS

I, JAPRIL DIAZ CATALUA, Filipino, of legal age and a resident of Piapi,

Dumaguete City, Philippines, after being duly sworn in accordance with law,
depose and state:

That I am a regular subscriber of Globe Mobile Pre-paid SIM Card with No.
09771800693;

That in the morning of January 29, 2017, I left my cellular phone with the
said SIM Card in it inside a pedicab/tricycle for hire;

That despite diligent search and efforts to locate said cellular phone, I could
not find the same such that I now believe that said is now lost beyond recovery
together with the aforesaid SIM Card;

As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and in support of my request / application for the replacement of the
said SIM Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 31th of January

2017, in Dumaguete City, Philippines.

JAPRIL DIAZ CATALUA

Affiant

SUBSCRIBED AND SWORN TO before me this JANUARY 31, 2017 at

Dumaguete City, Philippines, the affiant showing to me as proof of identification
his Phil Health I.D. No. 12-0255-14282-3.

Doc. No._______;
Page. No._______;
Book No._______;
Series of 2017