REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAGAYAN
) S.S.
CITY OF TUGUEGARAO
)
x-------------------------------------x
AFFIDAVIT OF LOSS
I, CHRISTIAN JOSHUA OLIVAS SEBASTIAN, of legal age, Filipino, single
and a resident of 12 Dunkin Drive, Caggay, Tuguegarao City, Cagayan, after having
been duly sworn to in accordance with law, depose and state:
1. That I am a holder of Automated Teller Machine (ATM) Card No. 3707079010 duly
issued in my favor by Landbank of the Philippines Capitol Branch on December 16,
2016;
2. That after receipt of said ATM card, I placed it in my wallet;
3. That sometime at three o clock in the afternoon (3:00 P.M.) yesterday, December
20, 2016 when I was
about to withdraw using my Landbank ATM card, I discovered that the same was no
longer in my
wallet;
4. That diligent efforts to locate the same proved futile;
5. That in view thereof, I now desire and hereby request Landbank to issue another ATM
card in lieu of the lost one;
6. That I bind myself to save Landbank harmless from any loss or damage that it may
incur in connection with the issuance of a new ATM card in lieu of the lost one;
7. That I am executing this affidavit to attest to the foregoing facts and for any legal
purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 21st
December 2016 in Tuguegarao City, Cagayan, Philippines.

day of

CHRISTIAN JOSHUA O. SEBASTIAN

Affiant
Voter's ID No. 1507-0038B-L2592COS10000
SUBCRIBED AND SWORN TO before me this 29th day of July 2013 in Makati
City, Metro Manila, Philippines, affiant exhibiting to me his valid proof of
identification.
Doc. No. 285;
Page No. 057;
Book No. 002;
Series of 2016.