REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LEYTE ) S.S.

CITY OF TACLOBAN )

AFIDAVIT OF LOSS OF ATM CARD

I, DANN WINSTON T. SANTO, Filipino, of legal age, and residing at Sto. Nino St. Brgyg Lusad,
Dagami, Leyte, after having been sworn according to law, hereby depose and state that:

1. I am the owner of a LandBank ATM Card with account number SA 1737050048 issued by
LandBank Real Branch;

2. On or about 3:00 PM of March 13, 2020, I discovered the loss of the said object under
the following circumstanes.

a. I always put that LandBank ATM card in my wallet.

b. On that afternoon of March 13, 2020 I was planning to give it to my partner for
safekeeping when I discovered that it was not on my wallet anymore.
c. I tried looking for it in my bag or in my car and I was not able to find it.

3. Despite diligent efforts, I could not find nor locate the same and I believe that it is truly
lost;

4. I am executing this affidavit to attest to the truth of the foregoing facts and to request
for a replacement of my LandBank ATM Card.

IN WITNESS WHWEROF, I have hereunto affixed my signature this 16th day of March 2020
at Tacloban City, Philippines.

Dann Winston T. Santo

Affiant
Competent Evidence of Identity
ID:
issued on:
at:

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below.
The affiant exhibited to me his competent evidence of identity as indicated above.
Signed this this 16th day of March 2020 at Tacloban City, Philippines.
WITNESS MY HAND AND SEAL.

Notary Public
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