REPUBLIC OF THE PHILIPPINES )

CITY AND PROVINCE OF ILOILO ) S.S.

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AFFIDAVIT OF LOSS

I,EDNIE PREVENDIDO JIMENA, of legal age, married, Filipino

and a resident of Brgy. Bakhaw, Mandurriao, Iloilo City, Philippines after
having been duly sworn to in accordance with law do hereby depose
and say that:

1. That I am a holder of a Bank Account No. 200022694908 with

Passbook duly issued by Maybank;

2. That I have been and usually keeping the said Passbook inside my
filing cabinet;

3. That sometime on August 18, 2015 in the afternoon, when I was about
to withdraw my money, I looked for my Passbook and ATM inside the
filing cabinet but the same were gone;

5. That I looked immediately for the said Passbook and ATM inside my
filing cabinet but despite my efforts of finding the said Passbook and ATM
my search for it and my hopes of finding the same proved futile;

6. Because of this, I declared the same to be lost and cannot be found;

7. I am executing this Affidavit of loss in order to attest to the truth of the

foregoing facts and for whatever legal purpose(s) this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day

of January 2019 at Iloilo City, Philippines.

EDNIE PREVENDIDO JIMENA

Affiant

The affiant whose name and personal circumstances are stated

above, personally appeared before me this 28th day of August 2015 in
the City of Iloilo, Philippines, presented the foregoing affidavit, signed
the same in my presence and affirmed under oath to the correctness of
the contents or allegations of the same.

The affiant was identified by competent evidence of identity,

namely a ____________________________ bearing his photograph and
signature.

Doc. No. 398;

Page No. 81;
Book No. VIII;
Series of 2015.