REPUBLIC OF THE PHILIPPINES )

CITY OF SAN FERNANDO ) Sc.

AFFIDAVIT OF LOSS

I, DANILO A. CANCIO, of legal age, married, Filipino and a resident of

San Jose Del Monte, Bulacanl, under oath, depose and state that:

1. I am an owner of one (1) unit Alcatel and a subscriber of Globe

Telecom;

2. Last October 28, 2017 at around 3:00 o’clock in the morning I

was in a poultry farm situated in Tarlac;

3. Since my phone was in low battery I charged it in outlet of the

said farm and forgot about it until I left the place;

4. After an hour, I remember my phone and went back to the said

farm;

5. However, my phone was no longer found on the place where I

left it;

6. I tried to look for it, but my effort went in vain;

7. That I execute this affidavit to attest to the truth of the

foregoing statements and to inform Globe Telecom of the lost of
the SIM card.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my

signature this 30th day of October 2015 in the City of San Fernando,
Pampanga.

DANILO A. CANCIO
Affiant

SUBSCRIBED AND SWORN to before me this 30 th day of October

2015 in the City of San Fernando, Pampanga and within the jurisdiction of the
Commissioning Court, affiant exhibited to me his Non-Professional Driver’s
License No. ____________________________