REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR: s.s.

MUNICIPALITY OF TAGO..)

AFFIDAVIT OF LOSS
(Checking Account)

I, JOSEFA T. NUEZA, Filipino, of legal age, and a resident of

Brgy. Poblacion, Marihatag, Surigao del Sur, Philippines, after having
been duly sworn to in accordance with law, depose and state:

1. That I am a depositor of Enterprise Bank, Marihatag

Branch, Surigao del Sur;

2. That as such, I was issued a corresponding Checking

Account by said bank;

3. That I lost the said Checking Account and its whereabouts

cannot anymore be ascertained despite diligent search undertaken;

4. That I am executing this Affidavit of Loss to attest to the

veracity of the foregoing and in support of my application for the
issuance of another Checking Account from the Enterprise Bank,
Marihatag Branch, Surigao del Sur.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 15th day of June, 2020 at Tago, Surigao del Sur.

JOSEFA T. NUEZA
Affiant

SUBSCRIBED AND SWORN TO before me this 15th day of June,

2020 at Tago, Surigao del Sur.

Doc. No.
Page No.
Book No. II
Series of 2020