Republic 

of the Philippines )
City of Quezon ) S.S.

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

AFFIDAVIT OF LOSS

I, _____________________________, Filipino,
of legal age and a resident OF _____________________________
Philippines, after being duly sworn in accordance with law, depose and state:

1. That I am a holder of Armed Forces and Police Savings Loans Association,

Inc. (AFPSLAI) passbook;

2. That the said AFPSLAI Passbook was lost on April 15, 2022 and despite
diligent search such that I now believe that said is now lost beyond
recovery;

3. That I now request the AFPSLAI to issue a new Passbook in lieu of the lost
one and I bind myself to surrender the lost Passbook in the event that the
same is found and/or located;

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

foregoing and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand

this____________at____________, Philippines.

_________________
Affiant

    SUBCRIBED AND SWORN TO before me this ___th day of _____ 2023

at Quezon City, Philippines, affiant exhibiting to me his valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2023.