REPUBLIC OF THE PHILIPPINES] S.S.

QUEZON CITY]

AFFIDAVIT OF OWNERSHIP WITH REQUEST FOR UNBLOCKING

I, _________________________________________ of legal age, Filipino citizen and presently residing at

________________________________________________________________________ with telephone
number_________________ and with office address at _________________________________________
and office telephone number ______________________ law do hereby depose and say:

1. That I am requesting all CMTS carriers to block the GSM handset that was lost/stolen in my
possession by an unidentified person/s as owner thereof with particulars as follows:

Make / Model / Type International Mobile Equipment Identification (IMEI)

SIM Card No./s

0 9
0 9

2. That I filed an affidavit of ownership and loss with undertaking before the NTC on
_____________________________ for blocking of said cell phone;

3. That on _____________________________, said unit was returned to me/recovered;

Check appropriate box:

That it has already been blocked and thus I am requesting the NTC for unblocking of said
unit to activate the usage of the same;

That it has not yet been blocked and thus I am withdrawing the affidavit of ownership and
loss with undertaking I filed with the NTC for blocking of said cell phone to exclude the
same from the NTC list of cell phones subject for blocking;

4. That in support of this request and as proof of my ownership of said cell phone unit, I attached
hereto the following documents, after making the original available for comparison:

_____ Photocopy of Affidavit of Ownership and Loss with Undertaking filed with NTC

Any one (1) of the following: OR Any two (2) of the following:

_____ Photocopy of passport _____ Photocopy of company ID/ school ID

_____ Photocopy of driver’s license _____ Photocopy of TIN/SSS/GSIS ID
_____ Photocopy of Postal ID

5. That I am executing this affidavit of ownership with request for unblocking to attest to the veracity
and truthfulness of the foregoing declaration and to be used for whatever legal intent and purposes
the same may thus serve.

FURTHER AFFIANT SAYETH NONE.

___________________________________
Signature Over Printed Name of Affiant

SUBSCRIBED AND SWORN TO BEFORE ME on this ______day of _______________, 20___, affiant

has exhibited to me his/her Community Tax Certificate No. ___________________ issued on
_______________________ at ________________________.

ADMINISTERING OFFICER