REPUBLIC OF THE PHILIPPINES

( CITY OF MAKATI ) S.S.

AFFIDAVIT OF LOSS

I, JORGE PALMA GABIN, of legal age, single, Filipino, and a resident of WELLINGTON
RESIDENCE BRGY. TRES CRUSES TANZA CAVITE, after having been sworn to in
accordance with law hereby depose and say that:

1. I am a holder of GLOBE NO. 09369506673 duly registered under my name.

2. That sometime on September 06, 2023, while traveling with my tricycle along
Remulla Drive going to my Vicinity in wellington residence, I accidentally lost the
aforementioned sim card with my cellphone.

3. That immediately after discovery of such loss or incident, I have exerted diligent
effort to recover the aforesaid cellphone and simcard and it was considered lost
for all intents and purposes.

4. I execute this affidavit to attest to the truthfulness of the foregoing information,

and to secure the replacement of the said card as it was mandatorily needed on
my day to day living and for whatever legal purpose it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 09TH day of

September 2023 in MAKATI City, Metro Manila, Philippines

JORGE PALMA GABIN

Affiant

SUBSCRIBED AND SWORN to before me this day of September 2023 in _______

City, Metro Manila Philippines. Affiant exhibited to me his competent evidence of
identity as ______________________.

Doc No. ______ NOTARY PUBLIC

Page No. _____
Book No. _____
Series of 2023