REPUBLIC OF THE PHILIPPINES)

QUEZON CITY)SS.
X-----------------------------------------X
 
 
AFFIDAVIT OF LOSS
 
I, Georgina A. Quiñones, Filipino, of legal age, and a resident of #27
Granada St., Valencia, Quezon City, Philippines, after having duly sworn to
in accordance with law, hereby depose and state: That-

1. On 05 August 2013 at around 8:00- 8:30 o’clock in the morning while

riding on a jeepney on my way home from Cubao to Gilmore, Quezon City,
my black Nokia 1202 company issued cellular phone slipped-off from my
pocket without my awareness; 

2. The said cellular phone contained my PLDT Landline Plus post-paid SIM
(Subscriber Identity Module) card with access number +632 359 6964, in
which all my important contacts were stored;

3. I exerted diligent efforts to locate my cellular phone and its SIM card
but to no avail and I therefore considered the same as lost and cannot be
found;

4. I am executing this Affidavit to attest to the truth of the foregoing

facts and to use the same for whatever legal purpose it may serve.

      
IN WITNESS WHEREOF, I have hereunto set my hand this ______________
in Quezon City, Philippines.
                                        

Georgina A. Quiñones
Affiant

      SUBSCRIBED AND SWORN to before me this _______________ in

Quezon City, Philippines, affiant having exhibited to me his TIN ID with no.
_______________ issued on ______________ at _____________.
 
Doc. No.____;
Page No.____;
Book No.____;
Series of 2013.