Republic of the Philippines)

Province of Quirino)
Municipality of Diffun) S.S.

AFFIDAVIT OF LOSS

I, DENALYN D. LEO, of legal age, Filipino, married and with residence

at P2 Baguio Village, Diffun, Quirino, after having been sworn to oath in
accordance with law, hereby depose and state:

1. That I am a holder of the LANDBANK ATM card with account

number _______________ issued by Landbank Quirino Branch;

2. That sometime on September 30, 2019, when I withdraw at

Robinson’s Place Santiago City I discovered that my
LANDBANK ATM card was no longer in my wallet where I used
to place it;

3. That despite diligent search and efforts to locate my ATM Card,

I could not find the same such that I now believe that it is now
lost beyond recovery;

4. Said ATM Card was not confiscated by any officer of the law or
the officers of LANDBANK by reason of any violation of any
law, ordinance, presidential decree or rules and regulation of
said bank; and neither was it offered as collateral for any loan;

5. That I am executing this affidavit to attest to the truth of the

foregoing facts and to request for a replacement of my
LANDBANK ATM card.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 4th

day of October, 2019 at DIFFUN, QUIRINO.

DENALYN D. LEO
Affiant

Subscribed and sworn to before me this 4th day of October, 2019 at

DIFFUN, QUIRINO.

Atty. MA. KAREN A. BALDONADO-

GUILLERMO
Notary Public
Until December 31, 2019
Doc. No.518 246 PTR No. 3218465/ 01-03-2018
Page No.105 51 Lifetime IBP No. 17396/05-20-2017
Book No. XIII ROLL No. 67812/05-26-2017
Series of 2019. MCLE Compliance No.VI 0013817/10-01-
2018
Diffun, Quirino