REPUBLIC OF THE PHILIPPINES )

NATIONAL CAPITAL REGION ) S.S.

PASAY CITY, METRO MANILA )
x----------------------------------------------x

AFFIDAVIT OF LOSS

I, NELVIN T. TABINAS, of legal age, Filipino citizen, and a resident of No. 9

Peony St. Barangay 184, Maricaban, Pasay City, after having been duly sworn to in
accordance with law, do hereby depose and state:

1. That I am the owner of Realme 3 touch screen cellular phone with SMART
prepaid SIM No. 09195325527 & TM prepaid SIM No. 09653192756 ;

2. That on 16 June 2021 at around 11:00 pm, the said cellular phone with the
SMART & TM prepaid simcard accidentally fell down from my bag while I was
riding my motorcycle while on my way home and despite diligent search made, I
can no longer find it since then and it was deemed permanently lost;

3. That I am requesting SMART COMMUNICATIONS and GLOBE TELECOM to

issue a replacement with the same SMART prepaid SIM No. 09195325527 &
TM prepaid SIM No. 09653192756;

4. That I am executing this affidavit to attest to the truth and veracity of the above
statement and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereby affix my signature this 17 th day of June 2021 in

Pasay City, Metro Manila.

NELVIN TABAT TABINAS

UMID No. 0111-6896930-9
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public this 17 th day of June
2021 in Pasay City, Metro Manila affiant exhibiting to me his above government issued
identification card as valid proof of his true identity.

Doc. No._______
Page No._______
Book No._______
Series of 2021