AFFIDAVIT OF LOSS

Republic of the Philippines)

City of Cauayan, Isabela ) s.s.

I, RODAMAE L. ALLAM, of legal age, Filipino, and a resident of San Fermin, Cauayan City, Isabela,
after having been duly sworn to in accordance with law, hereby depose and say that;

I am a holder and owner of the following;

ATM CARD-BPI- Savings Account -No.1159150896, Land Bank- Account No. 1077108838, CSC
Eligibility CARD-100102170256 and PRC CARD- 1757142 kept in my black wallet;

That said black wallet with these Cards kept in it was inadvertently lost /misplaced from my
possession on January 02, 2023;

That despite of the diligent search and efforts to locate my wallet (with the cards kept) , I could
not find the same such that I now believe I lost beyond recovery;

That I am executing this Affidavit of Loss to attest to the truth of the foregoing and to support
the application of the issuance of a new Cards as specified above in lieu or / replacement of these lost
cards and whatever legal intent this may serve .

In WITNESS WHEREOF, I have hereunto set my hand on this ___________day of

__________,2023 in Cauayan City, Isabela.

RODAMAE L. ALLAM
Affiant

Subscribed and Sworn before me this __________ day of ___________2023 in Cauayan City,
Isabela.

__________________________________
NOTARY PUBLIC
Doc. No.___
Page No.___
Book No.___
Series of 2023