Republic of the Philippines)

Davao City ) S.S

AFFIDAVIT OF LOSS

I, Leovilyn Cortina Ochigue, of legal age, single, Filipino, and a resident of Purok 29,
SPDA, Panacan, Davao City, after having been sworn to in accordance with law hereby
depose and state that:

1. I am the owner of a Subscriber Identity Module (SIM) card with number

09556472407;

2. On January 22, 2023, while rummaging through my bag, I noticed that my

cellular phone was missing;

3. The said SIM card was stored in my cellular phone;

4. Despite diligent search and efforts to locate my cellular phone I could not find
the same such that I now believe that said cellular phone is now lost and
beyond recovery together with the aforesaid SIM card;

5. As such, I am executing this affidavit to attest to the truth of the foregoing facts
and to request the issuance of a new SIM card with the same number to replace
the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ at

Davao City, Philippines.

Leovilyn Cortina
Ochigue
Affiant

SUBSCRIBED AND SWORN TO before me this ________________ at Davao City,

Philippines, affiant exhibited to me her Philippine Identification Card with ID No. 6102-1426-
8054-7091 as her competent evidence of identity.

Doc. No.:______;
Page No.:______;
Book No.:______;
Series of 2023.