Republic 

of the Philippines)
Province of Bukidnon) S.S.
City of Malaybalay )
x-----------x

AFFIDAVIT OF LOSS
I, BARBRA JOEY P. MORENO, Filipino, of legal age, married, and a
resident of Barangay Casisang, Malaybalay City, Bukidnon, Philippines, after being
duly sworn in accordance with the law, depose and state:

1. That I am the authorized representative and widow of the deceased

MARLON N. MORENO to transact and manage on his behalf pertaining
to his ACCOUNT AT Bukidnon Government Employees Multi-Purpose
Cooperative (BUGEMCO) with the following details below;

CAPITAL BUILD-UP PASSBOOK

ACCOUNT NO. 16-01435-6
ACCOUNT HOLDER NAME: MARLON N. MORENO
ADDRESS: Barangay Casisang, Malaybalay City

2. That the CAPITAL BUILD-UP PASSBOOK of the abovementioned account

at BUGEMCO was in the possession of my deceased husband, MARLON N.
MORENO, who passed away last June 7, 2022.

3. That sometime this week, the CAPITAL BUILD-UP PASSBOOK could not be

found in our house nor in the previous workplace of my husband and that
despite diligent search and efforts, the same could no longer be found
such that I now believe that it is now lost beyond recovery.

4. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and for whatever legal purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __ of July, 2022 at

Malaybalay City, Bukidnon, Philippines.

BARBRA JOEY P. MORENO

Affiant
SUBSCRIBED AND SWORN to before me this _____ day of July 2022 in Malaybalay City,
Bukidnon, Philippines. Affiant exhibited to me his competent evidence of identity as
__________________.

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2022.