Republic of the Philippines)

Province of Southern Leyte) S. S.

City of Maasin...............)

AFFIDAVIT OF LOSS

I, SHELLA MAY A. PESCO, Filipino, of legal age, married and a resident of Brgy.
Combado, Maasin City, Southern Leyte, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am a bona fide depositor of D’Asian Hills Bank;

2. That relative thereto, a Savings Passbook with Savings Account No. 07-000466
was issued in my favour;

3. That undesirably however, the aforesaid Savings Passbook was lost sometime in
January 2017, when we moved from Cebu to Maasin City;

4. That I have exerted my best efforts to locate and recover the aforesaid Savings
Passbook, but despite diligent search made, my efforts proved futile. I now
consider the same irretrievably lost;

5. That I am executing this affidavit to attest to the veracity of the foregoing, and for
whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto set/affixed my signature this

______________ at Maasin City, Southern Leyte, Philippines.

SHELLA MAY A. PESCO

Affiant

SUBSCRIBED AND SWORN TO before me this ______________ at Maasin City,

Southern Leyte, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2018