Date: ___________________________

To: Banco de Oro Unibank, Inc. (the “Bank”)

Hong Kong Branch

Dear Sirs,

Loss of Passbook
I/We, ____________________________________________________________________________ being
accountholder(s) of the Account No.: ________________________ hereby declare that the passbook of the
said account has been lost. I/We hereby request the Bank to close the said account and transfer the
outstanding balance(s) to a new account to be opened in my/our name(s).

I/We, further undertake to return the lost passbook to you for cancellation should it come into my/our
possession at any time.

In consideration of your accepting the above request, I/We hereby jointly and severally undertake to hold
you harmless and indemnified against all actions, suits, proceedings, claims, demands, costs, expenses,
losses and charges whatsoever which may be brought against you or suffered or incurred by you howsoever
arising out of your so doing or of any legal action taken against you in connection therein. My/Our
indemnity to you herein shall be in a continuous one and shall be irrevocable.

Yours truly,
In the presence of:

________________________________________ ________________________________________
(Please use signature(s) filed with the Bank) Signature of Bank Officer
Name of Officer: _________________________
Date: ___________________________________

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FOR BANK USE ONLY

Amount being transferred to A/C No. Prepared: Signature Verified:

Checked: