Republic of the Philippines)

CITY OF ZAMBOANGA. . . . . ) S.S.

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

AFFIDAVIT OF LOSS

I, ________________, of legal age, of legal age, and

residing at _____________________, Zamboanga City, after
having been sworn in accordance with law, hereby depose and
say:

That I am the owner of Savings Account No.

________________________ in the Bank of the Philippine
Islands (BPI), Veterans Avenue Branch, Zamboanga City, for
which the said Bank issued to me an Account Passbook;

That due to excusable neglect or simple inadvertence,

the said Passbook was lost or discovered missing from my
possession or otherwise misplaced in such a way that its
whereabouts has become completely unknown;

That I have exerted diligent efforts in the search for

the said Passbook but all proved futile and that the same
are now beyond recovery;

That I am executing this affidavit in order to

establish the loss of the said Passbook as a fact for all
the purposes that this may serve under the law;

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

____ day of __________ in the City of Zamboanga,
Philippines.

___________________
Affiant

SUBSCRIBED AND SWORN to before me on this ____ day of

____________ in the City of Zamboanga, Philippines.

Doc. No.____;
Page No. ___;
Book No. ____;
Series of 2012