Republic of the Philippines)

City of Davao )S.S.

x------------------------------------x

AFFIDAVIT OF LOSS
I, JHON NUEVO DAVO, of legal age, Filipino, single, and a resident
of PH-2 Violeta St., Brgy. Sto. Ni ño, Tugbok Dist., Davao City, after having
been duly sworn in accordance with law, hereby depose and say that:

1. I am the person whose personal circumstances are described in

this affidavit;

2. On (Date)_____________, my ATM card issued by ( name of bank

and which branch, ex. LandBank, Davao City branch
Office)_____________ was unfortunately lost while I was cleaning
our house;

3. I exerted due diligence and persistent efforts in locating said ATM

but to no avail and I now consider the same as irretrievably lost;

4. I am executing this Affidavit to attest to the truth and veracity of all

the foregoing and to use the same for whatever legal purpose it
may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

___________________ at Davao City, Philippines.

JHON NUEVO DAVO

Affiant

SUBSCRIBED AND SWORN to before me this _______________ at

Davao City, Philippines. Affiant, for purposes of identity, exhibited to me his
SSS UMID I.D No. 0111-7315031-0.

Doc No. ___;

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