Republic of the Philippines ]

City of Tagbilaran ] S.S.

AFFIDAVIT OF LOSS

I, CESAR P. LADESMA, Filipino, of legal age, married and a resident of Poblacion West
Garcia Hernandez, Bohol, Philippines, after being duly sworn in accordance with law, hereby
depose and say:

1. That I am a holder of an account with the Metro Bank, Tagbilaran City Branch (Metro
Bank– Tagbilaran), Tagbilaran City, Bohol;

2. That as such, I was issued a Passbook by the said bank with Savings Account No.
_______________________;

3. That said Metro Bank Passbook was in my possession but the same was
misplaced/lost in an event and place which I could no longer remember;

4. That I exerted diligent efforts to find and recover the aforesaid Metro Bank Passbook,
however, my efforts proved futile as until now, its whereabouts still could not be
ascertained, hence, I considered it to be lost for all intents and purposes;

5. That the said Metro Bank Passbook was not transferred to any person for
consideration or used as collateral to secure obligations;

6. That I execute this affidavit voluntarily to attest to the truth of the foregoing
statements to support my request with Metro Bank– Tagbilaran City Branch for the
issuance of another Metro Bank Passbook in lieu of the lost one;

7. That I hereby hold free and harmless the said bank for the issuance of another Metro
Bank Passbook in my favor and I undertake to surrender with the bank the aforesaid
lost Metro Bank Passbook in case it is found later on;

8. That further, I execute this affidavit for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this _________________ at

Tagbilaran City, Bohol, Philippines.

CESAR P. LADESMA
Affiant
Prof ID No. G10-99-007941
Issued by LTO Tagbilaraan City

SUBSCRIBED AND SWORN to before me this _________________ at Tagbilaran City,

Bohol, Philippines.