REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.

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

AFFIDAVIT OF LOSS

I, GERARDO L. TAN, of legal age, Filipino, single and

a resident of 2222 Washington Street, Pio del Pilar, Makati
City, 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. 123456789 duly issued in myfavor by Banco de Oro
Unibank, Inc. on January 12, 2010 in Makati City;

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

3. That sometime on July 20, 2013, when I arrived home from

work, I discovered that said ATM cardwas no longer in my
wallet;

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

5. That in view thereof, I now desire and hereby request BDO

to issue another ATM card in lieu of the lost one;

6. That I bind myself to save BDO 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 29th day of July 2013 in Makati City, Metro
Manila, Philippines.

Vo

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. _____;

Page No. _____;
Book No. _____;
Series of 2013.