Republic of the Philippines )

Province of Bulacan ) s. s.
Municipality of Baliwag )
AFFIDAVIT OF LOSS

I, LESLIE DE JESUS , single, of legal age, Filipino, and a resident of 117 Sitio Looban, Tabang, Plaridel,
Bulacan, after having been deposed in accordance with law, do hereby state :

That I am the owner and holder of TM (Touch Mobile) pre-paid SIM card issued by Globe Telecom
with mobile number 09056531816 ;

That I use the above-mentioned SIM card in my VIVO Y12 smartphone and use it for work and
personal use ;

That at about 5:30 in the afternoon of August 1, 2020, I went on a trip from out of town o Baliuag via
UV Express bringing with me the above-mentioned phone and SIM Card ;

That I hopped off the UV Express terminal at the Terminal at SM City Baliuag and was on my way
home when I realized that my phone was missing from the pocket of my pants ;

That I immediately went back to the Terminal to search for the missing phone but failed to find it ;

That I also alerted nearby mall security regarding the loss of my phone but unfortunately no one in
the vicinity saw it ;

That upon arriving home, I immediately tried to contact my phone number but it can no longer be
contacted ;

That I am executing this affidavit to attest to the truthfulness of the above-mentioned facts ;

That I am executing this affidavit to attest to the fact that the said TM prepaid SIM Card with mobile
number 09056531816 is now missing and beyond recovery despite my best efforts to retrieve
them and for asking from Globe Telecom a replacement SIM with the same mobile phone
number ;
That I am also executing this affidavit for any legal purpose it may serve.

In witness whereof, I have hereunto signed my signature this August 10, 2020 at Baliwag, Bulacan.

LESLIE DE JESUS
Affiant
Philhealth ID No. 21-025713644-7
NBI Clearance No. D222FLXE89-SR41721008

Subscribed and sworn to before me this August 10, 2020 at Baliwag, Bulacan,
and affiant showing to me her Philhealth ID and NBI Clearance.

ATTY. CRISTOBAL R. FERNANDEZ IV

NOTARY PUBLIC
Until December 31, 2020
PTR No. 4426306 /January 8, 2020
IBP OR No. 111069/ January 8, 2020
MCLE NO. VI 0028766 / September 19, 2019
Doc. No. __________ ; Roll No. 57387
Page No. __________ ;
Book No. __________ ;
Series of 2020 .