Republic of the Philippines )

City of ___________ ) S.S.

AFFIDAVIT OF LOSS

I, Inna Isabel M. Almira, Filipino, of legal age, single, and a resident of 16-A,
Sobrepeña Street, Brgy. Damayang Lagi, District 4, New Manila, Quezon City,
Philippines, after having been duly sworn in accordance with law, do hereby depose and
state that:

1. I am a bona fide owner of the prepaid SIM Card No. 09184600150;

2. On January 10, 2023, in Francesca Tower, Scout Borromeo St., Brgy. South
Triangle, Quezon City, I was removing the SIM card from my phone near an
open window when the fan suddenly blew it out the window as I was holding the
same;
3. Despite my very best efforts and exercise of reasonable diligence to find the said
item, I could not find the same such that I have good reason to believe the same
is now lost and beyond recovery; and
4. I am executing this affidavit in order to attest to the truthfulness and veracity of
the foregoing and to facilitate the replace of the said lost item above-described.

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

_____________ in _________________, Philippines.

Inna Isabel M. Almira

Affiant

Subscribed and sworn to before me this ______ day of __________ in

_____________________, Philippines.

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