AFFIDAVIT OF LOSS OF SIM CARD

I, _______________, Filipino, of legal age, and a resident of

_________________________, after being duly sworn in accordance with
law, depose and state THAT:

1. I am a regular subscriber/user of (Smart /Globe /Sun) Mobile SIM Card

with No. ____________;

2. In the afternoon of October __, 2018, I loaded my mobile number with

P500.00 worth of calls and texts;

3. When I got home, I placed my SIM card in my drawer for safekeeping

as I was then using up the remaining load of my spare SIM card which
was then inserted in my mobile phone;

4. At around ________ of October __, 2018, I discovered that my said

Mobile SIM Card was missing in my drawer;

5. Despite diligent search and efforts to locate said SIM card, I could not
find the same such that I now believe that said is now lost beyond
recovery;

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

the foregoing facts and in support of my request/application for the
replacement of the said SIM Card, together with its unused load of
P500.00.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day

of November, 2018 in _________________________, Philippines.

______________
Affiant

SUBSCRIBED AND SWORN TO before me, a notary public in and for

_____________________ this ____ day of November 2018 by the affiant
whom I identified through her __________ ID No.________________ and
who personally signed the foregoing instrument before me and avowed
under penalty of law to the whole truth of the contents of said instrument.

NOTARY PUBLIC

Doc. No.____;
Page No.____;
Book No.____;
Series of 2018.