REPUBLIC OF THE ____________)
__________________ CITY ) SS.
AFFIDAVIT OF LOSS
I, ____________________________, of legal age, and with address at ___________________________, under oath state:
1. THAT I am a registered owner of SMART Retailer Sim bearing No. _________________;
2. THAT in the afternoon of Saturday, _______________ 20__, my Nokia 3310 containing said SIM was stolen from our store by an unidentified culprit while I was busy conducting an inventory of the goods therein;
4. THAT I exerted due diligence and persistent efforts in locating my aforesaid cellphone and its SIM card but to no avail and I consider the same as lost and can no longer be found;
5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use the same for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I hereunto affix my signature this ___________ at Makati City.
SUBSCRIBED AND SWORN to before me this ______________ at Makati City, Affiant exhibiting to me his/her Community Tax Certificate No. ________________ issued on ________________ at ______________.
Doc. No. _____;
Page No. _____;
Book No. _____;