Republic of the Philippines )

Bacolod City )ss.

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

AFFIDAVIT OF LOSS
I, Atty. Ariel I. Malunes, Filipino, of legal age, and a resident of Brgy.
Estefania, Bacolod City, Philippines, after having sworn to in accordance with
law, hereby depose and say:

1. That I am a depositor of Banco De Oro (BDO) Bacolod Capitol-

Shopping Branch under the Savings Account No. 003010113026
which I was issued an ATM Card in relation thereto;

2. I was in Cebu City between January 3-5, 2016 and I could remember
having used the said ATM Card; that when I returned to Bacolod City
I could no longer locate my said BDO ATM Card;

3. That despite diligent search and efforts, I could no longer find the
same so that I believe that the same is lost beyond recovery;

4. I am executing this affidavit for purposes of declaring that the subject

BDO ATM Card under my name is lost and that I am requesting for
the issuance of a new ATM Card;

5. I attest to the truthfulness of the foregoing.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 7th

of January 2016 at Bacolod City, Philippines.

ARIEL I. MALUNES
Affiant

SUBSCRIBED AND SWORN TO before me this

__________________ the affiant personally appeared before me and exhibited
his Driver’s License with No. F01-04-005369 to expire on January 27, 2017.

Bacolod City, Philippines.

Doc. No.
Page No.
Book No.
Series of 2016