REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CEBU ) S.S.

MUNICIPALITY OF MINGLANILLA)

AFFIDAVIT OF LOSS

I, WILETA LAPUT SAGMON , Filipino, of legal age, married,

and a presently residing at 22 Capaculan, Brgy. Labangon, Cebu
City, after being duly sworn to in accordance with law, hereby
depose and say:

That I am a holder of an Automated Teller Machine Card

(ATM Card), with an account no. 109427595468, which was
issued by Union Bank, through mail;

That sometime on September 03, 2023 , I discovered that

the said ATM Card was placed in my wallet and it was
unfortunately fell somewhere else;

That said ATM Card could not anymore be found

notwithstanding my diligent efforts to locate the same, hence
considered as lost for all legal intents and purposes;

That this affidavit is executed in order that I could be issued

another ATM Card, in lieu of the lost one, and for whatever legal
purpose this may serve best;

That the contents of this affidavit are true and correct

according to my best knowledge and belief and that the same is
executed without any fraudulent intention against any person,
natural or juridical;

IN WITNESS WHEREOF , I have hereunto set my hand this

th
6 day of September 2023, in the Municipality of Minglanilla,
Province of Cebu, Philippines.

WILETA LAPUT SAGMON

Passport ID
I.D. No. P9745035B

SUBSCRIBED AND SWORN TO BEFORE ME, in the Municipality of

Minglanilla, Cebu, Philippines, this 6th day of September 2023. Affiant
identified by me through his competent evidence of identity, as above
indicated below his name and signature, known to me and to me known to
be the same person who executed the foregoing instrument, and they
acknowledged to me that the same is his free act and deed.

WITNESS MY HAND AND NOTARIAL SEAL.

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