REPUBLIC OF THE PHILIPPINES)

CITY OF BATANGAS) S.S.

AFFIDAVIT OF LOSS

I, RITA LOVELYN CLAMOR DELOS REYES, of legal age, Filipino, single, and
resident of Sta. Rita Aplaya, Batangas City after having been duly sworn to in accordance with law,
depose and state:
1. That I am a regular subscriber/user of Globe Mobile SIM Card with No. 09457448261;
2. That I usually put the said sim card inside my cellphone case;
3. That sometime in February 2022, I changed my cellphone case and I noticed that the said
sim card was missing;
4. That despite diligent efforts exerted, I could no longer locate, find or recover the said SIM
card, and to the best of my knowledge, the same is truly lost;
5. 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 replacement of the said SIM Card.
IN WITNESS WHEREOF, I have hereunto set my hand this 22nd day of March 2022 at
Batangas City, Philippines.

RITA LOVELYN C. DELOS REYES

Passport No. P1468877B
valid until 12-APRIL-2029
Affiant

SUBCRIBED AND SWORN TO before me this 22nd day of March 2022 at Batangas
City, affiant exhibiting to me her competent proof of identity.
.
Doc. No.___;
Page No.___;
Book No. VI
Series of 2022. ATTY. PRISCILLA ELIZEL M. PASCUA, R.N.
NOTARY PUBLIC
Notarial Commission No. 2020-54-R
Valid until December 31, 2022
PTR NO. 4070136/January 3, 2022/Batangas City
IBP No. 168843/December 30, 2021
Roll No. 68985
MCLE COMPLIANCE NO. VII-0001428
Valid until April 14, 2025