REPUBLIC OF THE PHILIPPINES

Parañaque City, Metro Manila

AFFIDAVIT OF LOSS

I, IRONMAN, Filipino, of legal age, married, and a resident of

Silangan St., Masville, Road St. Brgy. BF Homes, Parañaque City, having
been duly sworn in accordance with law, hereby depose and state:
1. That I am a holder of an ATM Card issued by Eastwest-Mandaluyong
Branch;
2. That sometime in early December 4, 2021, the said ATM-Card was
misplaced;
3. That I know for a fact that the said ATM-Card was not confiscated by
authorities nor been used for illegal or unauthorized means;
4. That notwithstanding the earnest effort to recover the said card, such
effort proves to be unsuccessful;
5. As such, I am executing this Affidavit of Loss to attest to the truth of the
foregoing and for the application for its replacement and for other legal
purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 9th day of

December 2021, at Parañaque, Metro Manila, Philippines.

IRONMAN
Affiant

SUBSCRIBED AND SWORN to before me this 9th day of December

2021, the affiant is personally known to me and exhibiting to me his Barangay ID
No. 2021-12345 issued by BF- Parañaque City.