Republic of the Philippines )

Province of La Union )S.S.

Municipality of Naguilian )
x----------------- --x

AFFIDAVIT OF LOSS
I, PANFILO P. MORALES JR., Filipino, of legal age, married, and resident of #5
Ricarte St. Barangay Ortiz, Naguilian, La Union, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

1. That I am a holder of an ATM card issued by the LANDBANK OF THE

PHILIPPINES in the City of San Fernando, La Union;

2. That I kept the said ATM in my wallet for safekeeping;

3. That sometime on May, 2019, at around past 2:00 o’clock in the afternoon, while I
was on board a jeepney on my way to Naguilian, La Union, my ATM card must
have slipped from my pocket. When I was about to look for said ATM card, I
discovered that it was already missing;

4. That despite diligent search and efforts to locate said ATM Card, I could not find it
such that I now believe that it is now lost beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing
and to support my application for the issuance of the above-mentioned ATM Card
from Landbank of the Philippines in lieu of the one that was lost and for all legal
intents and purposes that this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 17th day of June 2019 at
Naguilian, La Union, Philippines.

PANFILO P. MORALES JR.

Affiant
TIN ID # 257-369-930

SUBSCRIBED AND SWORN to before me this 17th day of June 2010 at Naguilian, La Union,
Philippines.