AFFIDAVIT OF LOSS

            I,  , a Filipino citizen, of legal age, married to, and a resident of Rugsuanan,
Vigan City, Ilocos Sur, after having been duly sworn in accordance with law, hereby
depose and say:

1. That I am a holder of a Smart Retailer Sim Card No. 0919-404-1437;

2. That I registered the said sim card on January 18, 2023 with a certificate of
registration control no. 20230118P011109142;

2. That I usually put said sim card inside my cellular phone if needed only;

3. That I noticed the loss when I opened my wallet and found that it was not there
sometime around March of 2023;

4. That despite diligent search and efforts to locate said card, I could not find it;

5. That I am executing the affidavit to attest to the truth of the foregoing facts and to
request for a replacement of my Smart Retailer Sim Card.

Further Affiant sayeth none. 

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day

of ______________ , 2023 in Vigan City, Ilocos Sur, Philippines.

 
____________________    

 
SUBSCRIBED AND SWORN before me this _____ day of ________________
2023, by affiant exhibited to me his Company I.D. No. 96-0250-T issued on October
9, 2019 at Tamag, Vigan City, Ilocos Sur
 
                                                                           
 
Doc.  No. ____:
Page No. ____;
Book No. ____;
Series of   2023.