thus the same may be considered lost for all intents and purposes

Republic of the Philippines )

QUEZON CITY, M. M.
)S.s.
x---------------------------------x

AFFIDAVIT OF LOSS
I, MITCHEL RECABO ROSALES I, of legal age, single, Filipino
and residing at Mainit, Surigao Del Norte, after having been duly
sworn to in accordance with law hereby depose and say that:
1.

I am a holder of a Passbook issued by the Siargao Bank;

2.

That sometime on November 2013, the abovecited Passbook was lost in my house;

3.

Diligent efforts were exerted to find said Passbook but to

no avail, thus the same may be considered lost for all
intents and purposes;

4.

I am executing this Affidavit to affirm the facts

alleged herein and for whatever legal purpose it
may serve him.

AFFIANT FURTHER SAYETH NAUGHT:

IN WITNESS WHEREOF, I hereby sign this Affidavit this 1st
day of August 2016, here in Quezon City, Metro Manila.

MITCHEL RECABO ROSALES I

Affiant
SUBSCRIBED AND SWORN TO before me this 1st day of
August 2016, in Quezon City, Metro Manila, the affiant showing to me
his Drivers License with ID no. K07-16-S02751 bearing his picture
and signature
Doc No.
Page No.
Book No.
Series of 2016