Republic of the Philippines )

Province of Isabela ) S.c.

City of Ilagan )
x- - - - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, SOLEDAD LAGUA NADAS, of legal age, Filipino, married, and a

resident of Purok 1, Camunatan, City of Ilagan, Isabela, under oath depose and
state:

1. That I am the same person executing this Affidavit;

2. That Development Bank of the Philippines (DBP) City of Tuguegarao,

Cagayan Branch issued a PCIC ATM Card to me with Card No. 4706-7639-9796-
1299;

3. That I usually keep the said card inside my cabinet in our house along
with other documents and important files;

4. That recently, I intended to use said PCIC ATM Card to withdraw my

money therein and I realized that it is nowhere to be found;

5. That I exerted diligent efforts to locate the said DBP ATM Card but all
efforts remained to be futile and in vain;

6. That I am executing this affidavit for the purpose of declaring that the
ATM DBP Card issued to me is beyond recovery and therefore lost;

7. That this Affidavit is also executed for the purpose of requesting the
issuance of a new DBP ATM Card in lieu of the lost one; and

8. That I am executing this Affidavit to attest to the veracity and

truthfulness of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 10th

day of November 2023 at the City of Ilagan, Isabela.

SOLEDAD LAGUA NADAS

Affiant

SUBSCRIBE AND SWORN to before me this 10th day of August 2023, at

the City of Ilagan, Province of Isabela. The identity of the affiant is established by
her National ID No.

ATTY. MARY GRACE M. CAMMAYO-GAOIRAN

Public Attorney II
Administering Oath
Pursuant to R.A. 9406

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