REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ) S. S.
CITY OF )

AFFIDAVIT OF LOSS

I, R, 53 years of age, widowed, Filipino, and a resident of Brgy. San Sebastian,

Balete, Batangas, after having been sworn to in accordance with law, hereby depose
and say THAT:

1. I have savings account with Card SME Bank, San Sebastian, Balete,
Batangas Branch and for such reason I was issued a Card SME Bank ID;

2. I last kept said ID inside my old bag, which I in turn hanged at the wall of our
house;

3. Sometime in Jan 2017, my son, C, was hospitalized at Granja Lipa City,

Batangas at I stayed with him there for about a week;

4. In May 2017, when I was about to get the above-stated ID, my bag was no
longer hanged at the wall of house;

5. When asked my household, my sister-in-law informed me that she cleaned

the house while I was gone, threw away and burned some old bags which
she thought were no longer being used;

6. I suspect that the my old bag, with the ID inside, was among the old bags
thrown away and burned;

7. I exerted earnest efforts to locate the same, but to no avail;

8. The aforesaid Card SME Bank ID is now presumed lost and beyond recovery;

9. I am executing this affidavit to attest to the truthfulness and veracity of the

foregoing statements and for whatever legal intents and purposes it may
serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this July 3, 2017 at

Tanauan City, Batangas, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this July 3, 2017 at Tanauan City,

Batangas, Philippines, affiant exhibiting to me her Voters ID with No., bearing her
picture and signature to prove her identity.