REPUBLIC OF THE PHILIPPINES )

. . . . . . . . . . . . . . . . . . . . . . . ) S.S

AFFIDAVIT OF LOSS

I, JULIE A. SANTOS, of legal age, Filipino with residence and postal address at
112 Dalig Street Brgy. 3rd District, Jalajala Rizal having been duly sworn to accordance
with law, do hereby depose and state;

1. That, I am a holder of Smart Prepaid Sim with sim card No. 09286652216;

2. That, the said sim card had been inserted on my personal phone;

3. That, last June 24, 2019 I discovered that my personal phone wherein the said
sim card had been inserted was lost and stolen;

4. That, efforts were exerted to locate my personal phone and the said Smart
Prepaid sim, but in spite of diligent search, the same cannot be located and
recovered;

5. That, I am requesting to the Smart Communications, Inc. to please replace and

issue a new Smart Prepaid Sim under the same sim card no. 09286652216 ;

6. That, I am executing this Affidavit to attest to the truth of the foregoing to

support my request and for whatsoever other legal requirement and intent it may deem
serve;

IN WITNESS WHEREOF, I have hereunto set my hands this___th day of

_______________ 2019 in Jalajala Rizal.

JULIE A. SANTOS
AFFIANT

SUBSCRIBED AND SWORN to before me this______th day of

_______________ 2019 in Jalajala Rizal.

DOC NO. ________

PAGE NO.________
BOOK NO.________
SERIES OF 2019