Republic of the Philippines

DONE: CITY OF BAGUIO

)
) SS.

AFFIDAVIT OF LOSS
I, ELLEN B. YARIS, of legal age, single, with residence and postal
address at 390 Agaynec, Poblacion, Tuba, Benguet, after having been duly
sworn to in accordance with law do hereby depose and state that:
1 I am an owner of a GLOBE SIM Card with number.
_______________________ and GLOBE ATM POWERPAY+(TXTBILIS);
2 However, the GLOBE SIM CARD and GLOBE ATM POWERPAY+
(TXTBILIS) were lost/misplaced when I went abroad;
3 I exerted diligent efforts to locate the said GLOBE SIM CARD and
GLOBE ATMPOWERPAY+(TXTBILIS) but the same could no longer be
found, hence, considered forever lost;
4 The said GLOBE SIM CARD and GLOBE ATM POWERPAY+(TXTBILIS)
have not been given nor pledged to anyone for any purpose
whatsoever, nor were taken or confiscated by the authorities for any
violation of any law or traffic law or regulations;
5 I am executing this affidavit to attest to the truth of my foregoing
statements and to support my request with the GLOBE COMPANY to
have my SIM CARD No. ___________________ which was lost to be
changed with the same number (___________________) and to replace
the GLOBE ATM POWERPAY+(TXTBILIS) in lieu of the lost one and for
all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 1 st day of
June, 2015, at Baguio City, Philippines.
ELLEN B. YARIS
Affiant
POSTAL ID No. 1858510
SUBSCRIBED AND SWORN TO before me this 1st day of June, 2015,
at Baguio City, Philippines. Affiant personally appeared before me and to be
the same person who executed this instrument.

MODESTO T. ANDONG

Notary Public
Commission No. 30-NC-14-R/Until: December 31, 2015
PTR No. 2010843/1-05-15/Baguio City
IBP No. 0980515/1-05-15/Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
MCLE COMPLIANCE No. V-0002709/July 3, 2014
Community Tax Certificate Number 15051806
Issued On: January 5, 2015
Issued At: Baguio City
No. 13-B, 2nd Floor Old Market Bldg.,

Magsaysay Ave., Baguio City, Philippines

Doc. No. 367;
Page No.74;
Book No.XII;
Series of 2015.