Republic of the Philippines )

Province of Bukidnon ) S. S.
Municipality of Lantapan )

AFFIDAVIT OF LOSS

I, HELEN M. LABIAL, of legal age, Filipino, and a resident of Alanib, Lantapan,

Bukidnon, after having been duly sworn to in accordance with law, hereby depose and
state:

1. That I am a holder of a Secured Bank Passbook;

2. That I have discovered that the above-mentioned passbook was lost in my

possession sometime in April 2018;

3. That despite due diligence of finding the same, all proved futile and the same
is now believed to be beyond recovery;

4. That I execute this affidavit to attest to the veracity of the foregoing statements
and to support for whatever legal intents and purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________ at Lantapan, Bukidnon, Philippines.

HELEN M. LABIAL
Affiant
Valid ID No.: ______________________
Issued by: _________________________

SUBSCRIBED and SWORN TO before me this ________________ at

Lantapan, Bukidnon, Philippines.

WITNESS MY HAND AND SEAL.

CARMILA CLAUDETTE BON BAGAY

NOTARY PUBLIC
Roll of Attorneys No. 67124/ May 23, 2017
Notarial Commission No. 34-17
For the Province of Bukidnon
Doc. No._____ Until December 31, 2018
Page No. _____ IBP O.R. No. 23741/ 01-10-2018
Book No. _____ PTR No. 7191138/ 01-10-2018
Series of 2018. TIN: 702-766-624-000