AFFIDAVIT OF LOSS

I, _______________________, Filipino, of legal age, with residential address at

_______________________________________________, after having been duly
sworn in accordance with law, depose and state that:

1. On April 8, 2023, our apartment was robbed, and various items were stolen;
2. Among the stolen items include a mobile phone with the SIM card bearing the
number ___________________________;
3. I am the lawful owner and subscriber of the mobile phone number
____________________, which was associated with the sim card lost due the
unfortunate incident;
4. The incident was immediately reported to the barangay;
5. Despite extensive searches and efforts to locate the mobile phone with the SIM
card bearing the number _________________________, the same was not
found and now believed to be lost beyond recovery;
6. I hereby declare that the loss of my SIM card and mobile phone was not a result
of any fraudulent or illegal activity; and
7. I am hereby providing this affidavit to affirm the accuracy of the preceding
information, with the intention of obtaining a SIM card replacement for the mobile
number _____________________________, and for any legal purposes it may
be required for.

IN WITNESS WHEREOF, I have set my hand this _________ day of

_____________ at ______________.

_________________________________
Affiant