REPUBLIC OF THE PHILIPPINES }

CITY OF SURIGAO } S.S.

x-----------------------x

AFFIDAVIT OF LOSS

I, JO3 LUCENA A. DEGUITO, Filipino, of legal age, and a resident of P-7, Sukailang,
Surigao City, after being duly sworn in accordance with law, depose and state that:

1. I am a member of the BJMP-MULTIPURPOSE COOPERATIVE (BJMP-MPC).

Consequently, I was issued a PASSBOOK in relation to my account therein.
2. At a date and for reasons unknown to me, I lost the said document.
3. As all efforts to find the same proved unrewarding, I now consider the said document
as lost beyond recovery.
4. I am executing this affidavit to attest to the truth of the foregoing matters; to support
my request for the issuance of a replacement to the said document; and for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I have set my hand this ________________ at Surigao City.

JO3 LUCENA A. DEGUITO

Affiant

SUBSCRIBED AND SWORN to before me on the date and place indicated above, the
affiant exhibiting to me his BJMP ID No. BN3-17-D200750, which expires on 12/31/2022, as
competent proof of identity.

Doc No. _____ ATTY. JASON OLIVER C. SUN

Page No. ____ Notary Public until December 31, 2020
Roll No. 65600; TIN 468-675-179
Book No. ____ IBP No. 056168; PTR No. 0806624
Series of 2019 MCLE Compliance No. VI – 0023667; 3/27/2019
2nd Floor, Del Castillo Bldg., Rizal St., Surigao City