Republic of the Philippines )

City of Butuan ) S.S.

AFFIDAVIT OF LOSS

I, CHRISTOPHER A. LANDICHO, of legal age, single, Filipino, and a

resident of Purok 4, Brgy. 15, San Ignacio, Langihan Road, Butuan City, under
oath, depose and states:

1. That I am a Talk N Text Sim Card holder bearing cellphone No.

0946-960-1546.

2. That sometime on the first week of August 2013 my Talk N Text

Sim Card was lost.

3. That I could not locate and find the said Sim Card despite my
diligent effort to locate the same.

4. That I am executing this affidavit to report the loss of my Sim Card

from the Smart Wireless Center Office, Butuan City and replace a new Sim Card
with the same number.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 14 th day of

August 2013 at Butuan City.

CHRISTOPHER A. LANDICHO
Affiant

SUBSCRIBED AND SWORN to before me this 14 th day of August 2013 in

Butuan City, Philippines, affiant exhibiting to me his valid Identification Card No.
______________ issued on ________________.

Doc. No. 244;

Page No. 49;
Book No. XV;
Series of 2013.