Republic of the Philippines)

City of ) s.s.
x-----------------------x

AFFIDAVIT OF LOSS

I,____________________ , Filipino, of legal age, single, and with residence at

___________________________ Philippines, after being duly sworn to in accordance
with law, hereby depose and state:

1. That I am the owner of a sim card with number _______________________,

issued and registered by Touch Mobile/ Globe Telecommunications;

2. That around the ______________________, said sim card was misplaced and
got lost;

3. That despite diligent search and efforts to locate my Sim Card, I could not find
the same, such that I now have reasons to believe that it is now lost and
cannot be recovered;

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

foregoing and to support my application for the issuance of a new Sim Card,
in lieu of the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ____day of __________ 20_at
______________, Philippines.

______________________________
AFFIANT

Subscribed and Sworn to before me this ____ day of ___________ 201_ at

__________________, Philippines, affiant exhibited her ____________________
Identification Card as herein above indicated.