REPUBLIC OF THE PHILIPPINES )

CITY OF MUNITNLUPA ) S.S

AFFIDAVIT OF LOSS

I, TERESITA TUPAS REVANO, of legal age, Filipino, with residence and

postal address at Blk. 4 Lot 5 Cedar Rd., La Marea Phase 1, San Pedro, San Pedro,
Laguna, after having been duly sworn to in accordance with law, do hereby deposes and
say that:

1. I am the holder of the PASSBOOK issued in my favor by the Bank of the

Philippine Island (BPI) Poblacion, Muntinlupa Branch under Account No.
008323-0923-04;

2. The said PASSBOOK was lost sometime on November 2019 in Davao City;

3. I took diligent effort in finding the same from the said act of finding the same
were proved to be futile, and that the act of finding that is an impossibility
hence its fact of lost and its consideration as such;

4. That I execute this affidavit in order to attest the truth of the above facts for all
legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature

this 20th day of July, 2020 in the City of Muntinlupa.

TERESITA TUPAS REVANO

Affiant

SUBCRIBED AND SWORN to before me this 20th day of July, 2020, in the City
of Muntinlupa, affiant having exhibited to me her Competent Evidence of Identity
bearing No. N03-89-077362-LTO.

Doc. No. _________;

Page No._________;
Book No. ________;
Series of 2020.