REPUBLIC OF THE PHILIPPINES )

CITY OF )

AFFIDAVIT OF LOSS

I, RENALYN O. SURIGAO, Filipino, married, of legal age, resident of Consolacion, Cebu,

Philippines, after having been sworn in accordance with law hereby depose and state that:

1. I am the owner of a G l o b e Sim Card with number 09560358006.

2. Sometime around March 5, 2024, I lost the above Sim Card under the following
circumstance:

a. Sometime around morning of the above said date, the said Sim Card cannot be found in
our house
b. I looked for it all over the house, but it was nowhere to be found

3. Despite diligent efforts exerted, I could not locate or recover the said Sim Card, and to
the best of my knowledge, the same is truly lost.

4. The said Sim Card has not been confiscated by any officer of the law or the issuing
agency or office due to the violation of any law, statute, order, rule or regulation.

5. I am executing this affidavit to attest to the truth of the foregoing and to request the
issuance of a new Sim card to replace the one that was lost.

SUBSCRIBED AND SWORN to before me this 5th day of March , 202 4 , affiant exhibiting
to me her competent evidence of identity by way of (ID Type and
number) issued at City on .

Notary Public

Doc No. ;
Page No. ;
Book no. ;
Series of 2024.