REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA )S. S.

AFFIDAVIT OF LOSS

I, GERALDINE A. ANQUILLANO, of legal age, Filipino, married and with

postal address at San Isidro, Lagangilang, Abra, after having been sworn
in accordance with law, do hereby depose and state, that:

1. The Jeannie’s Touch Manpower Solutions, Inc, was issued

me an Chinabank ATM;

2. Sometime June 2017, the said ATM was missed inside my

wallet;

3. Despite all diligent efforts the said Chinabank ATM, is

already beyond recovery;

4. I am executing this affidavit to attest to the truth of all the

foregoing facts and for whatever legal purpose this may serve.

AFFIANT FURTHER SAYETH NAUGHT.

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

day of September 2017, at the City of Manila, Philippines.

GERALDINE A.
ANQUILLANO Affiant

SUBSCRIBED AND SWORN to before me in person on this ______

day of September 2017, at the City of Manila, Philippines by GERALDINE
A. ANGUILLANO, who is personally identified by me as such person after
presenting to me her Unified Multi-Purpose ID No. 0111-6634692,
bearing her photograph and signature.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2017.