AFFIDAVIT OF LOSS

Republic of the Philippines)

Province of Cavite) S.S.)
City of Tagaytay
x---------x

I, RERICH BON PEJI, of legal age, Filipino, single and with present
residence and postal address at Patutong Malaki, Tagaytay City, after being
duly sworn to in accordance with law, hereby depose and state:

That I am a holder of a VIVO A8 cellular phone with TM Sim Card Number

09364763158 ;

That such was a prepaid account and I have been in possession of that
number for five (5) years already;

That sometime last month, my cellular phone was lost due to unknown
reasons;

That despite diligent search and efforts, I could not find it such that I
honestly believe that it is now beyond recovery;

That I am executing this affidavit in good faith and without any intention to
defraud or deceive; and

As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and for other reliefs as may be just and equitable specifically for
retention of the TM Mobile Number for my personal use.

IN WITNESS WHEREOF, I have hereunto set my hand this

___________at Tagaytay City, Philippines.

RERICH PON PEJI

AFFIANT
PHILHEALTH NUMBER 01-051903561-3

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and

in the Province of Cavite this_____________. Affiant personally came who is
known to me as the same person who signed the foregoing instrument
before me and avowed under penalty of law to the whole truth of the
contents of said instrument.

Doc. No. _____

Page No. _____
Book No. _____
Series of: 2021.