REPUBLIC OF THE PHILIPPINES)

CEBU CITY )S.S

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

AFFIDAVIT OF LOSS

I, ERLINDA C. CANENCIA, of legal age, Filipino, single and a resident of Brgy.

Zaragosa, Aloguinsan, Cebu, after having been duly sworn to in accordance with law,
depose and state:

1. That I am a holder of a bank passbook duly issued in my favor by FIRST

VALLEY DEVELOPMENT BANK sometime in year 2017;

2. That sometime on June 20, 2018, the above-mentioned passbook got misplaced
and cannot be located;

3. 4. That diligent effort to locate the same proved futile;

4. That in view thereof, I now desire and hereby request FIRST VALLEY
DEVELOPMENT BANK to issue another passbook in lieu of the lost one;

5. That I bind myself to save FIRST VALLEY DEVELOPMENT BANK harmless

from any loss or damage that it may incur in connection with the issuance of a
new passbook in lieu of the lost one;

6. That I am executing this affidavit to attest to the truth of the foregoing facts and
for any legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this May 22, 2021 in Cebu City,
Philippines.

ERLINDA C. CANENCIA
Affiant
Brgy ID no. 2019005623

SUBSCRIBED AND SWORN TO before me this May 22, 2021 in Cebu City,
Philippines. Affiant exhibiting to me his valid proof of identification.

Doc. No. ____;

Page No.____;
Book No.____;
Series of 2021.