Republic of the Philippines)

City of Zamboanga )s.s.

X------------------------------------X
AFFIDAVIT OF LOSS

I, ROGER C. MIRANDA, of legal age, single, Filipino,

and a resident of Bienvenido Drive, Canelar Moret, Zamboanga City,
Philippines, after being duly sworn in accordance with law, depose and
state:

That I am a regular subscriber/user of a Globe Mobile SIM Card

with No. 09172431223;

That in the afternoon of December 10, 2018, my Samsung

cellular phone with the said SIM Card is in my right jacket pocket and I
was buying something at the City Public Market at Magay;

That when I was about to go home, 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 28th day

of December 2018 at Zamboanga City, Philippines.

ROGER C. MIRANDA
Affiant
Barangay ID Control No. 280

SUBSCRIBED AND SWORN to before me on this 28 th day of

December 2018, in the City of Zamboanga, Philippines.

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