REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )

City of Dumaguete )

AFFIDAVIT OF LOSS

I, CLARIDEL C. DE LOS SANTOS, of legal age, Filipino, widow, and a

resident of Lasola Drive, Piapi, Dumaguete City Philippines, after having been duly
sworn in accordance with law, hereby depose and state:

1. That I am a Globe Telecom Subscriber with sim card No. 0997-2886013

2. That sometime around 6 August 2017, when I arrived home that night, I
discovered that my cellphone is no longer in my bag.

3. That it might have fell off in the motorcab that I was riding on my way home.
And unfortunately, I was not able to recall the side car number of the said
motorcab.

4. That despite diligent search and efforts to locate the said cellphone with the
above mentioned sim card number, and I could not find the same such that
I now believe that it is now lost beyond recovery;

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

foregoing and to support the application for the issuance of new one in lieu
of the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this October 23,

2017 at Dumaguete City, Philippines.

CLARIDEL C. DE LOS SANTOS

AFFIANT
SUBCRIBED AND SWORN TO before me this October 23, 2017 at Dumaguete
City, Philippines, affiant exhibiting to me her valid proofs of identification her UMID
ID with No. CRN-0111-0163160-7.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.