REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF VICTORIA) S.S.

Affidavit of Loss

That I, Mr. GERALD CABUNGASON PRESIADOS, of legal age, Filipino citizen,

married with residence and postal address at Bulo, Victoria, Tarlac after having duly sworn to in
accordance with the law do hereby and say;

That I am the owner and in possession of PASSBOOK with Account Number

118951005774 issued by PRODUCERS BANK, Victoria Branch.

That the aforesaid PASSBOOK was lost due to unavoidable circumstances when it was
unfortunately misplaced.

That despite of diligent effort has been made to look for the said item mentioned above
but prove futile and must be therefore considered it lost for all intents and purposes.

That I am executing this affidavit to attest to the truth of foregoing facts and to inform the
proper authorities concern and for whatever legal purpose this affidavit may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto set my hand on this 29th day of July, 2021 in
Municipality of Victoria

GERALD C. PRESIADOS
Affiant

SUBSCRIBED AND SWORN to before me on this 29 th day of July, 2021 in

Municipality of Victoria.

Doc. No. ________

Page No. _______
Book No. ________
Series of 2021