Affidavit of Loss-Masdo

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REPUBLIC OF THE PHILIPPINES )

CITY OF MASBATE ) S.S.

AFFIDAVIT OF LOSS
I, LARRY M. MASDO, Filipino, of legal age, married and a resident
of Barangay Poblacion, Batuan, Masbate, after having been duly sworn in
accordance with law, hereby depose and state:

1. I am a holder and/or possessor of an ATM Card duly issued by


the Landbank of the Philippines.

2. I used to put said ATM Card inside my wallet.

3. Sometime in 20 December 2016, I discovered that said ATM


Card was no longer in my wallet where I used to place it.

4. Diligent efforts to locate the same had proved futile.

5. I am executing this affidavit to attest to the truth of the


foregoing facts and for whatever legal purpose this may serve.

Affiant further sayeth naught.

10 January 2017, Masbate City, Masbate.

LARRY M. MASDO
Affiant

SUBSCRIBED AND SWORN to before me, in the City of Masbate,


this 10th day of January 2017, by affiant who exhibited to me his PNP
Retiree ID with No. NCR-1-1R14002139 issued on 6 January 2016.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2017.

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