REPUBLIC OF THE PHILIPPINES )

Province of Negros Oriental )

City of Dumaguete )

AFFIDAVIT

I, MARYJANE S. BANTOTO, of legal age, Filipino, single and a resident of

Masaplod Notre, Dauin, Negros Oriental, after having been duly sworn in
accordance with law, hereby depose and state:

1. That I am a Touch Mobile Subscriber with number 09351495281.

2. That sometime in October 20, 2018, when I reached home from work, I
discovered that my cellphone which used the said sim card was no longer in
my pocket and bag.
3. That I tried tracing back my track but to no avail.
4. That my phone might have fell off from my pocket while I was on my
way home.
5. That despite diligent search and efforts to locate my phone with the
said sim card, I could not find the same such that I now believe that
they are now lost beyond recovery.
6. As such, I am executing this Affidavit of Loss to attest to the
truth of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this October 23, 2018 at
Dumaguete City, Philippines.

MARYJANE S. BANTOTO

ID No. _____________
SUBCRIBED AND SWORN TO before me this October 23, 2018 at Dumaguete
City, Philippines, affiant exhibiting to me her valid proof of identification as
described above.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.