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Republic of the Philippines )

City of General Trias, Cavite )S.S.

AFFIDAVIT OF LOSS

I, ROSEMARIE RAFON JACOB, of legal age, Filipino, married, and with


address at PH2, B65, L10, BellaVita Subd., Brgy. Tapia, City of General Trias, Cavite,
Philippines, after having been duly sworn to in accordance with law, depose and state:

1. That I am a regular user of a Globe Mobile Subscriber Identity Module (SIM) card with
number 09673214147;

2. That the above-mentioned SIM card is registered with a Gcash account;

3. That sometime in May 2021, the said SIM card was misplaced and got lost while I was
at the vicinity of BellaVita Subd., Brgy. Tapia, City of General Trias, Cavite, Philippines;

4. Efforts were exerted to locate the said SIM card, but despite diligent search, it could not
be found and the same is now beyond recovery;

5. As such, I am executing this Affidavit to request to issue me the same number and Gcash
account, as well as attest to the truth of the foregoing and for whatever legal intents and
purposes it may duly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of


September 2021 at the City of General Trias, Cavite, Philippines.

ROSEMARIE RAFON JACOB


Affiant

SUBSCRIBED and SWORN to before me this 15th day of September 2021 at the
City of General Trias, Cavite, Philippines, affiant exhibited to me her passport with
number P6823315B, as competent proof of her identity.

Notary Public

Doc. No. 379


Page No. 77
Book No. VI
Series of 2021

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