(Affidavit of Loss Cellphone SIM Card)

Republic of the Philippines)

Province of Negros Oriental) S.S.
Cityof Dumaguete____________)
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AFFIDAVIT OF LOSS

I, EPHRAIM D. SALON, Filipino, of legal age and a resident of Lot 19, Block
11, Silliman Heights Subdivision, Junob, Dumaguete City, Philippines, after
being duly sworn in accordance with law, depose and state that:

1. I am a regular subscriber / user of a Globe Mobile SIM Card with No.

09972718052;

2. That in the morning of September 12, 2018, I lost my OPPO cellular phone
with the said SIM Card in Tagbilaran City while I was on my way to work riding
a pedicab;

3. 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;

4. 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.

EPHRAIM D. SALON
Affiant

SUBSCRIBED and SWORN TO before me on the date and the place indicated
below. The affiant exhibited to me his competent evidence of identity
________________issued on ________________ at _________________.

WITNESS MY HAND AND SEAL

Notary Public

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