Republic of the Philippines City of Baguio

) ) S.S

AFFIDAVIT OF LOSS I, JAYSON S. ESTEBAN, of legal age, student and with home address at Ipil Street, Canciller Avenue, Cauayan City, Isabela, after having been sworn according to law hereby depose and state: 1. I am presently enrolled at the Saint Louis University, Baguio City and temporarily residing at No. 228, SLU-SVP, Bakakeng New Site, Baguio City. 2. I was issued an ATM Card from the Chinabank, Baguio City, and I use the same for withdrawing my allowance sent to me by my parents. 3. Recently, I intended to use my said ATM Card to withdraw some funds but could not find the same from among my personal effects. 4. I searched for the ATM Card but could not find the same and I am declaring it as lost and beyond recovery, for legal intents and purposes. 5. I am executing this Affidavit of Loss to attest to the truth of the foregoing and for all legal intents and purpose the same may serve. IN WITNESS WHEREOF, I have hereunto set my hand this 18th day of February 2011, at Baguio City, Philippines.

JAYSON S. ESTEBAN Affiant

SUBSCRIBED AND SWORN to before me this 18th day of February 2011, at Baguio City, Philippines, affiant exhibiting to me his Saint Louis University school identification Number 2081526.

Doc. No. 12; Page No. 3; Book No. V; Series of 2011.

FRANCISCA MACLIING CLAVER Notary Public Until December 31, 2012 PTR No. 0414311;11-08-10; B.C. Roll No. 43004;5/4/98; Manila IBP Lifetime Memb. No. 04371 NA No. 02-NC-11R Rm 14A Second Floor BBCCC Bldg Assumption Road, Baguio City