Republic of the Philippines]

Legazpi City ]
x-----------------------------------------x

AFFIDAVIT OF LOSS

I, JEREMY GRIBIALDE, of legal age, Filipino citizen, single, and a resident of

Barangay #33, Purok 3B PNR Site, Legazpi City, after having been duly sworn to in
accordance with law, do hereby depose and state, that:

1. I am the owner of a Metrobank ATM Card, with the details of which I can
no longer recall;

2. I often put the said ATM Card in my wallet or in my bag;

3. On March 8, 2019, when I was at Legazpi City and was going to withdraw
money from my account, I found out that the said ATM Card was not anymore in my
wallet or in my bag;

4. Despite diligent efforts exerted to locate the said ATM Card, the same
could no longer be found and considered lost for all legal purposes;

5. I am executing this affidavit to attest to the truth of the foregoing facts

and for reissuance of ATM Card and for whatever legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this March 13, 2019 at
Legazpi City.

JEREMY GRIBIALDE
VIN: 0506-0347A-B2895JBG10000
Issued by: COMELEC

SUBSCRIBED AND SWORN to before me this March 13, 2019 at Legazpi City,
Philippines, affiant exhibited his Identification Card under his name and bearing his
photograph and signature as competent proof of his identity pursuant to the 2004
Rules on Notarial Practice.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.