REPUBLIC OF THE PHILIPPINES  )CITY     OF      MANILA                  )SS.X-----------------------------------------X  

AFFIDAVIT OF LOSS 

I, (insert name here), Filipino, of legal age, single and a resident of (insert address here), Philippines, after having duly sworn to in accordance with law,  hereby depose and say that:

 1.     I am the holder of a Subscriber Identity Modeule (SIM) Card Number (insert

number here) issued by Globe Telecom; 2.     I lost said SIM card on (insert date here) and that I exerted all

efforts to locate the same but I could not remember exactly where I placed/left it and it is considered lost for all legal purposes;

 3.     Said SIM Card was not confiscated by any officer of the law by

reason of any violation of any law, ordinance, presidential decree or rules and regulation of anything; and neither was it offered as collateral for any loan;

 4.     I am executing this affidavit to attest to the foregoing facts; IN WITNESS WHEREOF, I have hereunto set my hand this

______________ in the City of ___________, Philippines.                                                                     (Insert Name of Affiant)

     Affiant  SUBSCRIBED AND SWORN to before me this _______________ in the City

of ____________ Philippines, affiant having exhibited to me (his or her) community tax certificate with no. _______________  issued on ______________ at _____________. Doc. No.____;Page No.____;Book No.____;Series of 2013.