Republic of the Philippines )

Bacolod City )ss.

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

AFFIDAVIT OF LOSS
I, LOLITA I. MALUNES, Filipino, of legal age, and a resident of Don
Herminio Maravilla Village, Brgy. 1 Poblacion, E.B. Magalona, Negros
Occidental, Philippines, after having sworn to in accordance with law,
hereby depose and say:

1. That I am a depositor of Philippine National Bank Silay City

Branch under bank account number 476-511823-4;

2. In relation thereof, I was issued an ATM Card;

3. That sometime on August 2, 2018, while I was about to use my

said ATM Card, I just discovered that it is no longer inside my
wallet where I keep it;

4. That I exerted diligent search and efforts to locate the said ATM
card but I could no longer find it. I believe that the same is lost
beyond recovery.

5. Considering that I am using it for my pension, I badly need to be

issued a new ATM Card in lieu of the lost one.

6. That I am executing this affidavit for purposes of my application for

the issuance of my new PNB ATM Card.

7. I attest to the truthfulness of the foregoing.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 9 th

day of August 2018 at Bacolod City, Philippines.

LOLITA I. MALUNES
Affiant

SUBSCRIBED AND SWORN TO before me this __________________ the

affiant personally appeared before me and exhibited her competent proof of
identity.

Bacolod City, Philippines.

Doc. No.
Page No.
Book No.
Series of 2018