REPUBLIC OF THE PHILIPPINES)

CITY OF CALAMBA ) S.S.

x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x

AFFIDAVIT OF LOSS

I, ___________________, of legal age, single, Filipino, resident of and with

address at ____________________________, after having been duly sworn to in
accordance with law hereby depose and say;

That I am a holder of a _______________ with no. _________________;

That the aforesaid _____________ went missing maybe it was misplaced or was
dropped somewhere without my knowledge;

That I cannot locate the aforesaid _____________ thus it was considered lost;

That I am executing this affidavit for the purpose of attesting to the truth of all the
facts mentioned herein and for all legal intent and purposes.

IN WITNESS WHEREOF, I HAVE HEREUNTO set my hand this _______ day of

_______________ in Calamba City, Laguna.

_____________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _________ day of ___________ in

_________________ Affiant exhibited to me his ________________.

WITNESS MY HAND AND SEAL ………………

REPUBLIC OF THE PHILIPPINES)

CITY OF CALAMBA ) S.S.
x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x

AFFIDAVIT OF LOSS
 I, MHARC ANTONINO C. HILARIO, of legal age, single, Filipino, resident of
and with address at Blk. 2 Lot 34 Palao Canlubang, Calamba City, Laguna, after having
been duly sworn to in accordance with law hereby depose and say;

That I am a holder of a SMART SIM CARD with no. 0939-7266755;

That the aforesaid SIM CARD went missing maybe it was misplaced or was
dropped somewhere without my knowledge;

That I cannot locate the aforesaid SIM CARD thus it was considered lost;

That I am executing this affidavit for the purpose of attesting to the truth of all the
facts mentioned herein and for all legal intent and purposes.

IN WITNESS WHEREOF, I HAVE HEREUNTO set my hand this 27th day of February,
2024 in Calamba City, Laguna.

MHARC ANTONINO C. HILARIO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 27th day of February, 2024 in

Calamba City, Laguna. Affiant exhibited to me his DL: D22-17-002124 and TIN: 274-079-478-
000.

WITNESS MY HAND AND SEAL ………………

Doc No. 198 ATTY. FERNANDO M. ALONZO

Page No. 42 Notary Public
Book No. XV Not. Com. 40-2023-C until December 31, 2024
Series of 2024 For Calamba City, Bay, Calauan and Los Baños, Laguna
Lifetime IBP No. 018040-Laguna Chapter
PTR No. CC 8126654 - Feb. 07, 2023 at Calamba City
Atty's Roll No. 36298- MCLE Comp. No. VII-0029272