REPUBLIC OF THE PHILIPPINES)

________________________ ) S.S.

AFFIDAVIT OF LOSS
I, JULIO A. POBLADOR, married, Filipino, of legal age, with postal
address at Nagsulang, Lemery, Iloilo, Philippines after having been sworn in
accordance with law hereby depose and state:
1. That I am a holder of a Globe Prepaid Sim Card No.
09155811455;
2. That I usually put said sim card inside my cellular phone for
use;
3. That I lost the said phone where the said sim card was
inserted on March 12, 2016;
4. That despite diligent search and efforts to locate said card and
cellular phone, I could not find it;

5. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of my Globe
prepaid sim card.
IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of
March 2015 at Iloilo City, Philippines.
JULIO A. POBLADOR
Affiant
SUBSCRIBED AND SWORN TO before me this 13 th day of March 2016,
affiant
exhibited
to
me
his
CTC/Government
ID
No.
________________________bearing the affiants photograph and signature, thru
which his identity was confirmed.

Notary Public
Doc. No. _______;
Page No. _______;
Book No. ______;
Series of 2016.