Republic of the Philippines)

Malolos City, Bulacan ) S.S.

AFFIDAVIT OF LOSS

I, ADELIA J. BACUDO, of legal age, widow, Filipino and presently

residing at 11 J. San Miguel Street, Balubaran, Valenzuela City, after having
been duly sworn to in accordance with law do hereby deposes and states,
that:

1. I am a holder of a Globe G-Cash Sim Card with number 0995

6858697;

2. On August 29, 20220, at about 1:30 P.M., while I was fall asleep in
my sari-sari store, I noticed that my cellphone inserted with the
subject Sim Card was stolen, maybe I was victimized by a thief;

3. I have exerted diligent efforts to locate the same but all efforts are
all in vain; and

4. I executed this affidavit to attest to the truth of the foregoing facts

and for all legal intents and purposes it may serve.

Malolos City, Bulacan, September 27, 2022.

ADELIA J. BACUDO
Affiant

SUBSCRIBED AND SWORN TO before me this day 27th of

September 2022, at Malolos City, Bulacan, Philippines. Affiant exhibited to
me her TIN ID with No. 209-432-190-000.

Doc. No. 442;

Page No. 90;
Book No. XXII;
Series of 2022.