Republic of the Philippines)

Malolos City, Bulacan ) S.S

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AFFIDAVIT OF LOSS
I, ANALENE MABUTIN, of legal age, Filipino, and a resident of
2433 M. Delos Reyes, St. Gen. T. De Leon, Valenzuela City, after having
been duly sworn to in accordance with law do hereby depose and state,
that:

1. I am a holder of a Passbook issued by the SME Bank;

2. On January 31, 2020, in our residence at 2433 M. Delos Reyes,

St. Gen. T. De Leon, Valenzuela City, while cleaning our house
and upon checking my documents, I found out that the said
Passbook was missing;

3. The above-stated Passbook might have been misplaced at our

house and could no longer be located;

4. I have exerted diligent efforts to locate the same but all my efforts
proved to be all in vain; and

5. I am executing this Affidavit of Loss to attest the truth of the all

foregoing statements and to inform the authorities for all legal
intents and purposes it may serve;

IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd

day of February 2020, at Malolos City, Philippines.

ANALENE MABUTIN
Affiant

SUBSCRIBED AND SWORN to before me this 3rd day of

February 2020. Affiant exhibited to me her _____________________.

Doc. No. 381;

Page No. 78;
Book No. XIV;
Series of 2020.