REPUBLIC OF THE PHILIPPINES)

CITY OF TACLOBAN ) S.S.

AFFIDAVIT OF LOSS
I, MARICRIS GRANTOS ESCALIENTE, of legal age, Filipino, married, and a resident
of Milagrosa Subdivision, District IV, Burauen, Leyte, after having been duly sworn to in
accordance with law, depose and state:

1. That I am a holder of an Automated Teller Machine (ATM) Card duly issued in my favor
by Eastwest Bank sometime on 2015 or 2016 in Tacloban City;

2. That I used to put said ATM card in my wallet;

3. That sometime on 2017, our house in Milagrosa Subdivision, District IV, Burauen, Leyte
was renovated and we decluttered our house and dispose some of our things;

4. That sometime on August 2022, I discovered that said ATM card was no longer in my
wallet;

5. That diligent effort to locate the same proved futile;

6. That in view thereof, I now desire and hereby request EastWest Bank to issue another
ATM card in lieu of the lost one;

7. That I bind myself to save Eastwest Bank from any loss or damage that it may incur in
connection with the issuance of a new ATM card in lieu of the lost one;

8. That I am executing this affidavit to attest to the foregoing facts and for any legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of August 2022 in
Tacloban City, Philippines.

MARICRIS GRANTOS ESCALIENTE

Affiant
UMID No. CRN-006-0092-9090-9

SUBSCRIBED AND SWORN TO before me this this 27th day of August 2022 in
Tacloban City, Philippines, affiant exhibiting to me her competent evidence of identity by way of
UMID ID issued on May 2018.

Doc No. _____

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Series of 2022.