Republic of the Philippines )

Taal, Batangas ) S.S.

AFFIDAVIT OF LOSS
I, THELMA C. ARTISTA, of legal age, widow, Filipino, and resident of Brgy. Bihis, Sta.
Teresita, Batangas, after being duly sworn according to law, hereby depose and state that:

1. I am an account holder of a UnionBank account with account number:

5726032686 under the account name, THELMA C. ARTISTA.
2. As such, I was issued a UnionBank ATM card.

3. On 15 November 2023, I was looking for the said ATM card but I was unable
to find the same.

4. I may have misplaced the same in my house or dropped it after I made my

last withdrawal.

5. I tried to find the said ATM card in the place where it is usually kept and in
the places I went that day but I cannot locate the same.

5. Despite diligent efforts exerted, Unionbank ATM card can no longer be

located, found or recovered, and to the best of my knowledge, the same is truly lost.

6. The said ATM card has not been confiscated by any officer of the law or the
issuing office or agency due to the violation of any law, statute, order, rule or regulation.

7. I am executing this Affidavit to attest to the truth of the foregoing statements

and to request the issuance of a Unionbank ATM card in lieu of the one which was lost.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________________ at Taal,

Batangas.

THELMA C. ARTISTA
Affiant

SUBSCRIBED AND SWORN to before me this ______________________, affiant exhibited

to me his/her Competent Evidence of Identity by way of Senior Citizen ID No.: 00707,
issued by OSCA Sta. Teresita, Batangas
.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2023.