REPUBLIC OF THE PHILIPPINES)

CITY OF )S.S.

AFFIDAVIT OF LOSS

I, PAWN BENIK A. ANGELES, single, of legal age, Filipino citizen, with residence at
4345 Matanzas St., Brgy. Palanan, Makati City, Philippines, having been sworn in accordance
with law hereby depose and state:

1. That I am a holder of a Globe Mobile Prepaid Subscriber Identity Module (SIM) Card
No. 09177377369;

2. That I usually insert my sim card inside one of my cellular phones alternatively for use;

3. That I lost the said sim card last November 13, 2021;

4. That despite diligent search to locate the missing sim card since then, all my earnest
efforts were in vain, and I consider the same as lost beyond recovery;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and in
support of my application requesting for a replacement of my Globe prepaid sim card.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of December 2021
at ________________, Philippines.

PAWN BENIK A. ANGELES

Affiant

SUBSCRIBED AND SWORN TO before me, this _____ day of December 2021, affiant
exhibited to me his valid Philippine Passport No. P9113396A issued on __________________ at
______________________, bearing the Affiant’s photograph and signature, thru which his
identity was confirmed.

NOTARY PUBLIC

Doc. No. _____

Page No. _____
Book No. _____
Series of 2021.