AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)

_________________________) S.S.

I, RICH JAY T. LOTRINIA, Filipino, 22 years old, residing at 1242 Abad Santos Extension Tondo,
Manila after having been sworn in accordance with law hereby depose and state:

1. I am a regular user of a Globe Mobile Subscriber Identity Module Module (SIM) Card with No.
095666897536 since 2016;
2. On October 2017, at about noontime, when I the premises of the cab I took to go to work, I also
left my cellular phone where the said SIM card is inserted;
3. I failed to recover my cellular phone and the said SIM Card despite the diligent search and
earnest efforts to contact and locate said phone, and I consider the same as lost and can no longer
be found;
4. I am executing this Affidavit to attest to the truth of the foregoing facts and in support of my
application for the replacement of the said SIM card and for whatever legal intents and purposes
it may serve.

Affiant states nothing further.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 25th day of May 2018 in Manila
City, Philippines.

Affiant

ID Details

SUBSCRIBED AND SWORN TO before me this ______ day of ______, 2018 in Manila City
Philippines, affiant exhibited his TIN Identification Card as herein above indicated.