REPUBLIC OF THE PHILIPPINES }

PROVINCE OF CAGAYAN }S. S.

CITY OF TUGUEGARAO }

AFFIDAVIT OF LOSS

I, Jeremiah Ezekiel B. Loremia, of legal age, Filipino, single, and a resident of 27-A
Arugay St., Caritan Centro, Tuguegarao City, Cagayan after being duly sworn to in accordance
with law, hereby depose and state that:

1. I am a holder of an Automated Teller Machine (ATM) Card No. 000610311549 duly

issued in my favor by Banco de Oro (BDO), on August 2023 in Caloocan City, Manila;

2. That when I went to an ATM to check my balance, I noticed that my ATM was not in
my wallet anymore.

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

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

5. That I bind myself to save BDO harmless from any loss or damage that it may incur in
connection with the issuance of a new ATM card;

In witness hereof, I hereby set my hand this 23rd day of May 2024 in Tuguegarao City,
Cagayan.

JEREMIAH EZEKIEL B. LOREMIA

Affiant

SUBSCRIBED and SWORN to before me this _____ day of ____________________.

Affiant exhibiting to me his/her_______________________issued at ____________________
and issued on ___________________.

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