Republic of the Philippines)

Province of  Cavite ) S.S.

Municipality of Alfonso ) 

AFFIDAVIT OF LOSS

I, LOLITA C. RESURRECCION, Filipino, of legal age, and with residence at

Purok 4, Taywnak Ilaya, Alfonso, Cavite, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

1. That, I maintain a Savings Account with the First Integrity Bank Alfonso, Cavite
Branch) with an account no. 58-01472-0;

2. However, upon checking my files, I found out just recently that the said
Passbook was misplaced and cannot be found and its whereabouts cannot be
ascertained despite due and diligent search made and undertaken such that I
now believe that the same is lost beyond recovery;
 

3. That I now request the First Integrity Bank to issue a new Passbook in lieu of the
lost one and I bind myself to surrender the lost Passbook in the event that the
same is found and/or located;

4. That I bind myself to indemnify First Integrity Bank for any loss and damage it
may incur by reason of its issuance or replacement Passbook;

5. That each and every fact herein stated is true and I am willing to testify before
any court of justice to substantiate the truth of each and all the said facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 1st day of September
2020 at Province of Cavite, Philippines.

LOLITA C. RESURRECCION
Affiant

SUBSCRIBED AND SWORN to before me this 1st day of September 2020 at

Alfonso, Cavite. Affiant exhibiting to me her OSCA 10230-Alfonso, Cavite.

WITNESS MY HAND AND SEAL.

Doc. No. 510 ;

Page No. 103 ;
Book No. LXXXIII ;
Series of 2020.