Republic of the Philippines)

City of Tacloban ) s.s.

Province of Leyte )
x-------------------------------x

AFFIDAVIT OF LOSS

I, SARAH B. BANILAR, of legal age, married, Filipino and a

resident of #5 Agua, Dulce St., Ormoc City, Leyte, after having been duly
sworn to in accordance with law do hereby depose and say;

1. That I am holder of BDO ATM Card which was issued at BDO-

Ormoc Branch, Ormoc City, Leyte;

2. That above-mentioned ATM Card was kept inside my drawer,

however, just recently when I was to make use of it I noticed that the
same could no longer be found believed to have been misplaced;

4. That I have made diligent efforts to locate above-mentioned ATM

Card and but the same have proven futile, hence, for all intent and legal
purposes I considered it lost and beyond recovery;

5. That in view thereof, I am now requesting the BDO-SM Branch,

Tacloban City to issue another ATM Card in lieu of the lost one;

6. That I hereby hold the BDO-SM Branch, Tacloban City, free and
harmless from any loss or damage that it may incur by reason of or in
connection with the issuance of a new ATM Card;

IN WITNESS WHEREOF, I have hereunto affix my signature this

11 day of December 2019 at Tacloban City, Philippines.
th

SARAH B. BANILAR
Affiant

SUBSCRIBED AND SWORN to before me this 11th day of December

2019 at Tacloban City, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2019