Republic of the Philippines)

Province of Cagayan ) S.S.

Tuguegarao City )
x--------------------------------x

AFFIDAVIT OF LOSS

I, JOHN MICHAEL B. BALIGA, of legal age, Filipino, and a

resident of Balzain Highway, Tuguegarao City, Cagayan, after having
been duly sworn to in accordance with law, deposes and states:

1. That I am a regular subscriber / user of a Globe Mobile

SIM Card with No. 0905-2902-676;

2. That It is unfortunate that last May 07, 2017 I misplaced

my cellphone and earnest efforts have been exerted to
locate the same but all proved futile, thus, it is presumed
to have been lost for all intents and purposes;

3. That as such, I am executing this Affidavit of Loss to attest to

the veracity and truthfulness of the foregoing statement and in
support of my request / application for the replacement of the
said SIM Card and to recover the numbers stored in the
phonebook of said Sim Card.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this ___ day of May 2017 in Tuguegarao City, Cagayan, Philippines.

JOHN MICHAEL B.
BALIGA
Affiant

ID No.___________________

SUBSCRIBED AND SWORN to before me this ___ day of May

2017 in Tuguegarao City, Cagayan, Philippines.

Doc. No._____
Page No.____
Book No. ____
Series of 2017.