Affidavit of Loss Cellphone SIM Card

Republic of the Philippines)

Province of_________________) S.S.
City/Municipality of____________)
x------x
AFFIDAVIT OF LOSS
I,____________, Filipino, of legal age and a resident of ____________, Philippines, after being
duly sworn in accordance with law, depose and state:
That I am a regular subscriber / user of a (Smart / Globe / Sun)Mobile SIM Card with
No._____________;
That in the afternoon of _____________, I forgot my (O2 / Sony-Ericsson / Motorola / Samsung)
cellular phone with the said SIM Card in it inside my car which I have parked along
____________;
That when I returned to my car at around________, I discovered that my cellular phone was
missing together with my said Mobile SIM Card which was inside the said cellular phone;
That despite diligent search and efforts to locate said cellular phone, I could not find the same
such that I now believe that said is now lost beyond recovery together with the aforesaid SIM
Card;
As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and in
support of my request / application for the replacement of the said SIM Card.
IN WITNESS WHEREOF,I have hereunto set my hand this____________at____________,
Philippines.
Affiant
JURAT)