AFFIDAVIT OF LOSS OF ATM CARD

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) SS.

I, , Filipino, of legal age, single and a resident of after having been duly sworn in accordance
with law, hereby depose and say:

1. That I am a holder of the =

2. That I used to put said ATM in my wallet;

3. That sometime on April 14, 2018, when I arrived home from my dorm, I discovered that my
BDO-ATM card was no longer in my wallet where I used to place it;

4. That diligent effort to locate the same had proved futile;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request
for a replacement of my BDO-ATM Card.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 16th Day of April 2018 at
Quezon City, Philippines.

Gillian M. Albay
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for ______________________
This ____ day of _________ 20___. This affiant, whom I identified through the following
competence of identity: (School ID No: 2017-102991), valid from 2017-2018 issued by
University of Sto. Tomas, personally signed the foregoing instrument before me and avoided
under penalty of law to the whole truth of the contents of said instrument.

Notary Public

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Series of 2018.