AFFIDAVIT OF LOSS OF ATM CARD

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) SS.

I, SARAH T. MOSCOSA, Filipino, of legal age, married to ALLAN N. MOSCOSA, and a resident
of Lot 57, Block 3 Phase 1-A Sub-Urban, San Jose, Rodriguez Rizal, after having been duly sworn
in accordance with law, hereby depose and say:

1. That I am a holder of the PNB-ATM card with account number 304439100019 issued by PNB-
Batasan Branch;

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

3. That sometime on December 8, 2011, when I arrived home from work, I discovered that my
PNB-ATM card was no longer in my wallet where I used to place it;

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

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a
replacement of my ATM-PNB card.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 12th day of December 2011
at Quezon City, Philippines.

_Sarah T. Moscosa________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________
this ____ day of ____________ 20___. The affiant, whom I identified through the following
competent evidence of identity: (HOR ID No. 5802), valid from 2010 to 2013 issued by House of
Representatives, personally signed the foregoing instrument before me and avowed under penalty of
law to the whole truth of the contents of said instrument.

Notary Public

Doc. No. ........;

Page No. .......;
Book No. .......;
Series of 2011.
 AFFIDAVIT OF LOSS OF DIPLOMA

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY ) SS.

I, MA. CHRISTINE B. SILVESTRE, Filipino, of legal age, single, and a resident of 131 Dr. Sixto
Antonio Ave., Maybunga, Pasig City, after having been duly sworn in accordance with law, hereby
depose and say:

1. That I am the owner of the COLLEGE DIPLOMA with a degree of Hotel and Restaurant
Management from Jose Rizal University, Mandaluyong City dated April 3, 2011;

2. That I used to put said DIPLOMA in my folder;

3. That sometime on December 5, 2011, I went to a computer shop when I arrived home, I
discovered that my folder was no longer in my bag where I used to place it;

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

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a
replacement of DIPLOMA from Jose Rizal University .

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________

2011 at ____________, Philippines.

_________________________________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________
this ____ day of ____________ 2011. The affiant, whom I identified through the following
competent evidence of identity: ______________, valid from _______ to ______ issued by
___________________, personally signed the foregoing instrument before me and avowed under
penalty of law to the whole truth of the contents of said instrument.

Notary Public

Doc. No. ........;

Page No. .......;
Book No. .......;
Series of 2011.