Republic of the Philippines) of

Batangas )s.s.
X X

AFFIDAVIT OF LOSS

I, IMELDA P. ANGELES, Filipino, singl, of legal age, resident of Brgy. San Pedro II,
Malvar , Batangas, Philippines, after having been sworn by law hereby depose and state
that:

1. I am the owner of a lost card holder who had two ATM Cards issued by the same bank
which it’s Landbank of the Philippines;

2. Sometime around June 11, 2024, around 4: 00 pm, I couldn’t find the two ATM cards
and I lost the above ATM card under the following circumstances;

3. Despite diligent efforts exerted, I could not locate or recover the said card holder and
ATM card, and to the best of my knowledge, the same is truly lost;

4. The said cardholder and ATM card had not been locate and not confiscated by any
officer of the law or the issuing agency or office due to the violation of any law, statute,
order, rule, or regulation;

5. If the lost cardholder and ATM card should hereafter be found or located, I undertake to
forward or surrender the same to the company where I worked for appropriate disposal;

6. I am executing this affidavit to attest to the truth of the foregoing and to request the
issuance of a new ATM card to replace the one that was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 27th of June, 2024, in Malvar,
Batangas, Philippines.

IMELDA P. ANGELES
Affiant
Issued ID: Senior ID
ID No.: 3340p

SUBSCRIBED AND SWORN to before me on this 27th day of June 2024, in Malvar,
Batangas Philippines.

Doc. No. ;
Page No. ;
Book No.
; Series of 2024.