REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ILOCOS NORTE )

MUNICIPALITY OF PAOAY )SS.

AFFIDAVIT OF LOSS

I, GRACE MARIEPHIL MAMACLAY GONONG, of legal age, and a

resident of Brgy. Paratong Paoay, Ilocos Norte, Philippines, under oath and
states:

1. That I am a regular subscriber / user of Globe Mobile SIM Card with

No. 0917-158-0043 with account of GCASH;

2. The said SIM Card is in my possession;

3. That sometime last of January 2020, said SIM Card was misplaced and
got lost;

4. That despite diligent search and efforts to locate said SIM Card, I could
not find the same such that I now believe that said is now lost beyond
recovery;

5. That as a consequence thereof, I am respectfully requesting for

generally purposes;

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

the foregoing and in support of my request / application for the transfer
a fund the above-mentioned Sim Card to my new account on
GCASH/SIM Card.

IN WITNESS HEREOF, I have hereunto signed my name this

___________at Paoay, Ilocos Norte, Philippines.

GRACE MARIEPHIL MAMACLAY GONONG

Affiant
I.D No. DL: A03-18-002144

SUBSCRIBED AND SWORN TO before me this,______________ at

Paoay, Ilocos Norte, Philippines.

Doc. No. _______

Page No. ______
Book No. ______
Series: ________