Republic of the Philippines)

City/Municipality of____________) S.S.

AFFIDAVIT OF OWNERSHIP AND LOSS CELLPHONE WITH SIM CARD

I, ___________, Filipino, of legal age, with postal address ______________________after

been duly sworn in accordance with law, hereby depose and say that:

1. I am the owner/holder and a regular user of Globe Mobile Subscriber Identity Module (SIM)
Card with No. _________________ since 2012.

2. I am the owner of the stolen iPhone 7 Rose Gold, IMEI _________________, Serial Number
____________________ with tempered glass and floral casing.

3. On June 4, 2019, between 3:30 to 4:30pm, my iPhone 7 with said Sim Card inserted was
stolen. I was walking along General Malvar Avenue Araneta Center Cubao QC—passing along
Isetann Grocery, Aurora Tower, Manhattan Parkway going towards Mercury Drug to cross
Aurora Blvd and went inside BDO Aurora Yale to transact. Inside BDO I have noticed that I
am missing my iPhone 7 in my black backpack. I have called my number and somebody
already turned it off.

4. I failed to recover my iPhone 7 with said SIM Card despite diligent search and earnest efforts
to contact and locate the said phone.

5. I have immediately activated my “Lost iPhone Mode,” texted and activated to the emergency
message via Find My iPhone and started to tract my iPhone however it was offline since then.

6. My iPhone has a passcode and icloud activated. However, I started to change my passwords
on my emails and accounts for security purposes. My fear is that the thief may use my SIM
number for phishing of credit card and personal details.

7. On the same day I went to seek assistance from security guards to help me and went to Police
Station 9 Camp Panopio to file an official Police Report.

8. My friends and I tried to contact the said SIM since it was lost but it was always off. However,
on June 8, 2019, my friends and I tried to call again and it rang twice on 2 occasions. After
calling again, someone already turned it off. I fear that this person might be using it for unlawful
purposes on my account.

9. I am executing this Affidavit to attest to the truth of the foregoing facts and in support of my
application for the replacement of the said SIM Card and for whatever legal intents and
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________________at

___________________________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this __________ day of ___________ 2019 at

_____________________________. Affiant exhibiting to me his document no. ___________ issued
on ____________________ at _____________________.

Doc No. ___________

Page No. __________
Book No. __________
Series 2019