Republic of the Philippines )

Province of La Union )S.S.

Municipality of Naguilian )
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AFFIDAVIT OF LOSS
I, MARK EDREM H. DUARTE, Filipino, of legal age, single and a
resident of Dal-lipaoen, Naguilian, La Union, Philippines, after being duly
sworn to in accordance with law, hereby depose and state:

1. That I am a holder of an ATM card issued by Eastwest Bank in the

City of San Fernando, La Union;

2. That I kept said ATM card in a pouch for safekeeping;

3. That on June 30, 2019 at around 1:00 – 5:00 pm, while I was on my
way to Lingsat, San Fernando City, La Union, said wallet must have
dropped from the side pocket of my pants;

4. That inside said pouch is the above-mentioned ATM card;

5. That despite diligent search and efforts to locate said Eastwest ATM
Card, I could not find it such that I now believe that it is now lost
beyond recovery;

6. As such, I am executing this Affidavit of Loss to attest to the truth

of the foregoing and to support my application for the issuance of
the above-mentioned ATM Card from Eastwest Bank in lieu of the
one that was lost and for all legal intents and purposes that this
affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of

July 2019 at Naguilian, La Union, Philippines.

MARK EDREM H. DUARTE

Affiant
Driver’s License ID # A04-18-006433

SUBSCRIBED AND SWORN to before me this 4th day of July 2019 at

Naguilian, La Union, Philippines.