Republic of the Philippines)

Province of_________________) S.S.

City/Municipality of____________)
x------------x

AFFIDAVIT OF LOSS

I, Filipino, of legal age and a resident of, after being duly sworn in accordance with law,
depose and state: That I am a regular user of a Globe Mobile SIM Card with No. ; That in
the morning of I lost my cellular phone with the said SIM Card in it. 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 for the replacement of the said SIM Card.

IN WITNESS, WHEREOF, I have hereunto set my hand this

Affiant

(JURAT)