AFFIDAVIT OF

LOSS OF ATM
CARD
REPUBLIC OF
THE
PHILIPPINES )
QUEZON CITY )
SS.I,
SARAH T.
MOSCOSA
, Filipino, of legal
age, married
to ALLAN N.
MOSCOSA, and
aresident of Lot
57, Block 3 Phase
1-A Sub-Urban,
San Jose,
Rodriguez Rizal,
after having
beenduly sworn in
accordance with
law, hereby
depose and say:1.
That I am a holder
of the PNB-ATM
card with account
number
304439100019 iss
ued by PNB-
Batasan Branch;2.
That I used to
put said ATM card
in my wallet;3.
That sometime on
December 8, 2011,
when I arrived
home from work, I
discovered that
myPNB-ATM
card was no longer
in my wallet
where I used to
place it;4. That
diligent effort to
locate the same
had proved
futile;5. That I am
executing this
affidavit to attest
to the truth of the
foregoing
facts and to
request for
areplacement of
my ATM-PNB
card.
IN WITNESS
WHEREOF
, I have hereunto
affixed my
signature this 12
th
day of December
2011at Quezon
City,
Philippines. _Sara
h T.
Moscosa________ 
(Signature of
Affiant over
Printed Name)
SUBSCRIBED
AND SWORN TO
before me, a
notary public in
and for
_______________
______ this ____
day of
____________
20___. The
affiant, whom I
identified through
the
followingcompete
nt evidence of
identity: (HOR ID
No. 5802), valid
from 2010 to 2013
issued by House
of Representatives
, personally signed
the foregoing
instrument before
me and avowed
under penalty
of law to the
whole truth of the
contents of said
instrument.
Notary Public
 Doc. No.
........;Page
No. .......;Book No.
.......;Series of
2011