REPUBLIC OF THE PHILIPINES )

PROVINCE OF MASBATE ) S.S.

AFFIDAVIT OF LOSS

I, HAROLD C. LARGADO, of legal age, Filipino, single and with residence

address at Barangay Togoron, Monreal, Masbate, subscribing under oath, depose and
state:

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

Development Bank of the Philippines-Masbate City Branch, with Account No.
5364356257.

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

3. On 10 December 2018, I discovered that said ATM Card was no longer in

my wallet where I placed 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 and for
whatever legal purpose this may serve and in support for my request for the replacement
of said ATM Card.

Affiant further sayeth naught.

Masbate City, Masbate, 1 March 2019.

HAROLD C. LARGADO
Affiant

SUBSCRIBED AND SWORN to before me this 1st day of March 2019, in

Masbate City, Masbate, by affiant who exhibited to me his PRC ID with No. 1613419
which is valid until 2/6/2021.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2019.