Republic of the Philippines )

City of Zamboanga . . . . . . .) S.S.

x-------------------------------x)

AFFIDAVIT OF LOSS

I JADE S. JACKARIA, of legal age, married, Filipino, a resident of Purok

4, Sta. Maria, Zamboanga City after having been subscribed to an oath, hereby
depose and say THAT:

1. That I am a regular user of a Globe Sim card with no. of 09156621285 since
2001;

1. I used to place said Sim Card inside my Passport Holder, together with my
passport for safekeeping;

2. However, sometime last October 26, 2019, I discovered that said Sim Card was
missing;

3. All my efforts to recover the said Sim Card were in vain;

4. I am executing this affidavit for the purpose of affirming the truth of the
foregoing statements and in support of my request for the replacement of the
said sim card and for any legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 7th day of November
2019 at Zamboanga City, Philippines.

JADE S. JACKARIA
Affiant
Driver’s License no. J04-15-007777

SUBSCRIBED AND SWORN to before me this 7th day of November 2019 at

Zamboanga City, Philippines. Affiant exhibited her valid identification card bearing
number as above-written.

Doc No. 443;

Page No. 90; ATTY. GIOVANNI P. GUEVARA
Notary Public for Zamboanga City
Book No. I; Until December 31, 2019
Series of 2019. Notarial Commission No. 68-2018
PTR OR NO. 1806757, 1/04/2019, Z.C.
IBP OR NO. 063794, 1/07/2019 Z.C.
Roll of Attorneys No. 70466
2nd Flr., Reyes Building, Gov. Alvarez St.
Zamboanga City