Republic of the Philippines)

City of Cebu………………………) S.s

AFFIDAVIT OF LOSS

I, JENNY REKHA ALIMASAC, Filipino Citizen, of legal age, single and a resident of
Barangay Punta Princesa, Cebu City after having been duly sworn in accordance with
law, hereby depose and say:

1. That I am an employee of the Cebu City Government with the position of

Administrative Aide I with Employee Number 52866;

2. That as employee of the Cebu City Government, I was issued an ATM card by the
Land Bank of the Philippines – Plaza Independencia Branch with Savings Account
No. 1457288502;

3. That on March 25, 2018, I went to Toledo, Cebu to visit my relatives and I placed
my LBP ATM inside my wallet;

4. That a few hours later, I discovered that my wallet which contains my LBP ATM
was missing from my bag and despite diligent efforts to locate the wallet, it is
irretrievably lost:

5. 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 5th of April, 2018 in
Cebu City, Philippines.

JENNY REKHA ALIMASAC

Affiant

SUBSCRIBED AND SWORN TO before me on the date and at the place indicated
below. The affiant exhibited to me her competent evidence of identity. Signed this 5th of
April, 2018 in Cebu City, Philippines.

WITNESS MY HAND AND SEAL.

Notary Public
Doc. No._____:
Page No._____;
Book No._____;
Series of 2018.