REPUBLIC OF THE PHILIPPINES}

MALOLOS CITY } S.S.

PROVINCE OF BULACAN }

AFFIDAVIT OF LOSS

I, JAIME GARCIA EVARDO, of legal age, Single, Filipino citizen and

with postal and residence address at Montero St., Barangay III
(Poblacion), Maria Aurora, Auroa, Bulacan, after having been sworn to
in accordance with law, do hereby depose and say, that:
1. I am the holder of an Automated Teller Machine (ATM) Card
with Account Number. 62:302007302 issued by China Bank Savings Malolos
City, Bulacan;
2. Unfortunately, sometime in March 1, 2017 at around 5:00
o’clock in the afternoon, while riding a Tricycle on my way going to
Meycauyan, I learned that my ID case together with my ATM Card, got lost
while in transit;
3. I exerted all efforts to locate the afore-mentioned ATM Card
but to no avail;
4. The loss of said ATM Card was not due to any violation of law
but because of the reason stated herein;
5. I am executing this affidavit to attest to the truth of all the
foregoing facts, and to secure a replacement for my ATM Card and for all
legal intents and purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

19th day of July 2017, here at Malolos City, Bulacan.

JAIME GARCIA EVARDO

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of July 2017,

here at Malolos City, Bulacan. As proof of identity, affiant exhibited to me
his Voter’s ID with No. 7707-0003B-C1785JGE10000

ATTY. KENNETH N. MERCADO

Public Attorney II
Public Attorney’s Office
Pursuant to RA 9406