REPUBLIC OF THE PHILIPPINES )

CITY OF CAVITE ) S.S.

AFFIDAVIT OF LOSS

I, ROYCE JOHN QUINONES SARI, of legal age, Filipino, and a resident

of , B15 L6 Park Place Village, Anabu 1-D, Imus, Cavite, after having been duly
sworn to in accordance with law, hereby depose and state:

1. That I am a lawful holder of Sim Card No. +63 921 255 0866 issued by
Smart Communications, Inc.;

2. That sometime on June 2020, I noticed that the said Sim Card were
missing;

3. Despite diligent search and efforts to locate the said Sim Card, I could not find the
same such that I now believe that it is now lost beyond recovery;

4. Identifications submitted for proof of identity:

Driver’s License No.: N04-06-016849

5. That I am executing this affidavit to attest to the veracity of the foregoing

facts and for whatever legal purpose it may serve under the law.

IN WITNESS WHEREOF, I have hereunto set my hand this 8 th day of July,

2020 at Cavite City, Philippines.

ROYCE JOHN Q. SARI

Affiant

SUBSCRIBED AND SWORN to before me this 8th day of July, 2020 at Cavite
City, Philippines, affiant exhibited to me his Driver’s License No. N04-06-
016849.

NOTARY PUBLIC

Doc. No. 3050

Page No. 86
Book No. IV
Series of 2020.