Republic of the Philippines ]

Province of Bohol ]
Municipality of Carmen ] S.S.

AFFIDAVIT OF LOSS
(Re: AMWSLAI PASSBOOK)

I, GREGORIO B. ALIMPOLOS, Filipino, of legal age, married and a resident of

Guadalupe, Carmen, Bohol, Philippines, after being duly sworn in accordance with law, hereby
depose and say:

1. That I am a Passbook with account no. 003-10-012969-1 duly issued by Armed

Forces and Police Savings and Loan Association, INC. (AMWSLAI) Tagbilaran City,
Bohol, Philippines;

2. That said AMWSLAI Passbook got lost last December 2022;

3. That I exerted diligent efforts to find and recover the aforesaid AMWSLAI Passbook,
however, my efforts proved futile as until now, its whereabouts still could not be
ascertained, hence, I considered it to be lost for all intents and purposes;

4. That the said AMWSLAI Passbook was not transferred to any person for
consideration or used as collateral to secure obligations;

5. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements to support my request for the issuance of another AMWSLAI Passbook in
lieu of the lost one;

6. That further, I execute this affidavit for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 28th day of April, 2023 at
Carmen, Bohol, Philippines.

GREGORIO B. ALIMPOLOS
Affiant
National ID No. 2810-7250-9358-7527
Issued by the Philippine Statistics Authority (PSA)

SUBSCRIBED AND SWORN TO before me this 28th day of April, 2023 at Carmen,
Bohol, Philippines.