REPUBLIC OF THE PHILIPPINES)

City of Cebu) S.S.

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

AFFIDAVIT OF LOSS

I, KRYSTLE PEARL A. PREJOLES, Filipino, of legal age, single, and a resident of Tungkil,
Minglanilla, Cebu, after being duly sworn in accordance with law, depose and state:

1 That I was issued a Debit Card with EastWest Bank Tabunok/Talisay branch;

2 That to my surprise, I discovered last April 2019 that the said Debit Card could not be

found;

3 As all efforts to find the same proved unrewarding, it is now safe to conclude that

recovery of the same is an impossibility;

4 Thus, I execute this affidavit to establish its loss and to support my application for the

issuance of a new Debit Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 5th day of July, 2019 at Cebu City,

Philippines.

KRYSTLE PEARL A. PREJOLES

affiant

SUBSCRIBED AND SWORN to before me, this 5th day of July, 2019 at Cebu City, Philippines, by
the Affiant who is personally known to me who exhibited her Passport with No. P2228186B issued at
Philippine Embassy Madrid on May 21, 2019.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.