Republic of the Philippines)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS
I, GAIZA BRACE, Filipino, single, of legal age, and a resident of Shrine
Hills, Matina, Davao City, Philippines, after being duly sworn to in accordance
with law do hereby depose and say that:
1. I am a plan holder of Globe Telecommunications Company. As such, I
was issued a Lenovo A500 cellular phone and a Globe sim card;
2. However, sometime on July 27, 2015 in the morning, I left such phone
at the office I am working. When I returned to check, the phone can no
longer be found;
3. Notwithstanding diligent efforts exerted to find it, the same was not
found, recovered, or located, hence, considered lost and destroyed for all
intents and purposes;
4. I am executing this affidavit without any fraud or intent to deceive on
my part and I forever free any person from any liability that may arise
from this circumstance;
5. I am therefore executing this affidavit to attest to the truth of all the
foregoing and to apprise Globe Telecommunications Company of such
fact of loss and for all other legal purposes this affidavit may serve.
AFFIANT FURTHER SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 2nd
day of September 2015, at Davao City, Philippines.

GAIZA BRACE
Affiant
TIN ID No. 422-756-503
SUBSCRIBED and SWORN to before me, in the City of Davao, this 2 nd
day of September 2015, affiant exhibiting to me her competent evidence of
identity first written above below her name.
Doc. No. ______

Page No. _____

Book No. _____
Series of 2015.