REPUBLIC OF THE PHILIPPINES)

CITY OF ANGELES ) S.S.

x-------------------------------------x

AFFIDAVIT OF LOSS

I, CARLITO P MALINAO , of legal age, Filipino, married and a

resident of 795 R.A Canlas Street, Springside, Pandan, Angeles City, after
having been duly sworn to in accordance with law, depose and state:

1. That I am a holder of two(2) Automated Teller Machine (ATM) Cards.

Described as follows:
A. Land Bank ATM Card issued at Landbank Clark Pampanga Branch with SA
No.1587 0839 53
B. PNB PSSLAI ATM Card issued at Philippine National Bank San Fernando
Branch with card no. 592108 095 0073753

2. That I used to put said ATM card inside my wallet;

3. That sometime on March 15, 2016, when I arrived home from work, I
discovered that my wallet where I always place my id is nowhere to be
found;

4. That diligent effort to locate the same proved futile;

5. That in view thereof, I now desire and hereby request from the above
banks to issue another ATM cards in lieu of the lost one;

6. That I bind myself to save the aforementioned banks 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 ___th

day of March 2016 in Makati City, Metro Manila, Philippines.

CARLITO P. MALINAO
Affiant
PNP ID No. 15K160339
 SUBCRIBED AND SWORN TO before me this ____th day of March
2016 in Angeles City,Philippines affiant exhibiting to me his valid proof of
identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2016.