REPUBLIC OF THE PHILIPPINES

MUNICIPALITY OF CAINTA
x------------------------------------------x

AFFIDAVIT OF LOSS

I, MANUEL ALFRED SALAS DE LEON, Filipino, of legal age, single and a

resident of 1074 CORREGIDOR ST. MANUGUIT, TONDO, MANILA, METRO
MANILA after being duly sworn to in accordance with law, depose and state that:

1. As a Subscriber, I was issued a TM/Globe sim card with No. 09954559766;

2. On or about November 21, 2021, I lost my phone TM/Globe sim card was
missing and I exerted all efforts to locate this thing but I could no longer find it;

3. Said TM/Globe sim card has not been confiscated by any officer of the law
or by the officers of the law for violation of any law, ordinance, decree or the rules
and regulations of any commission;

4. As all diligent search and efforts to find the same proved futile, it is now safe
to assume that said TM/Globe sim card is now lost beyond recovery;

5. As such, I execute this affidavit to attest to the truth of the foregoing facts, to
support my application for the issuance of a new TM/Globe sim card, and for
whatever legal purpose that this affidavit may serve;

6. FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my signature this ____ day of July
2021 in the Municipality of Cainta Rizal, Philippines.

AFFIANT

SUBSCRIBED AND SWORN to before me on this ____ day of May 2020 in the
Municipality of Cainta Rizal, Philippines.

NOTARY PUBLIC

Doc. No. _____;

Page No. _____;
Book No._____;
Series of 20___.