REPUBLIC OF THE PHILIPPINES)

CEBU CITY) SS

AFFIDAVIT OF LOSS

I, ALMARIE JOYCE ISRAEL GIMENA, of legal age, Filipino, single and resident of Pusok , Lapu-
Lapu City, Cebu, after being sworn in accordance with law, depose and say:

1. That I am the lawful owner of a Passbook issued by Wealth Bank

Development Corporation;

2. That sometime on January 12, 2022, around afternoon, I was having an errand
and I kept the above-mentioned item inside my bag for safe keeping;

3. However, after arriving at home, I noticed that my Passbook was already

missing and it might have accidentally fallen out from my bag while
travelling;

4. That despite my diligent to search for my Passbook it could not be found.

Hence the same is deemed lost and at a point beyond recovery;

5. That the said above-mentioned item have not been encumbered, sold,
pledge, assigned, alienated, transferred, or give as collateral for any debt or
obligation to or in favor of any person or entity;

6. That I am executing this affidavit to attest to the truth and veracity of the
foregoing facts so that I may be issued a new Passbook in lieu of the lost
one, and for whatever legal purpose this may serve.

IN WITNESS WHEREFORE, We have hereunto affixed our signature this 2 nd day of

September, 2022, at Cebu City, Philippines.

ALMARIE JOYCE ISRAEL GIMENA

Affiant
CRN-021-1379-0868-9
Unified Multi-Purpose ID

SUBSCRIBED AND SWORN to before me, a notary public for and in the City of Cebu,
this 2 day of September 2022 at Cebu City; affiant who personally appeared before me with
nd

their competent evidence of identity above, and who signed this instrument in my presence,
and avowed under the penalty of law to the whole truth of its contents.

WITNESS MY HAND AND SEAL on the date and at the place above-written.

Doc.No._____;
Page No.____;
Book No.____;
Series of 2022.