REPUBLIC OF THE PHILIPPINES )

CITY OF SAN FERNANDO, [P] ) S.S.

AFFIDAVIT OF LOSS

I, EILEEN PARAS PAULE, of legal age, Filipino, Married, and a

resident of Road 1 Phase 1, Villa Barosa Subd., Dolores, City of San Fernando,
Pampanga, subscribing under oath, depose and state that —

1. I was previously issued ATM cash card by Pag-ibig San Fernando

Branch, City of San Fernando, Pampanga;

2. The ATM cash card got lost or misplaced for 2 weeks now and I can
no longer find the same despite diligent efforts. Hence, I now consider it beyond
recovery;

3. The said ATM cash card has not been confiscated by any officer of
the law or the issuing office or agency due to the violation of any law, statute,
order, rule or regulation;

4. Despite diligent efforts exerted, I could no longer locate, find or

recover the said ATM cash card by Pag-ibig San Fernando Branch, City of San
Fernando, Pampanga, and to the best of my knowledge the same is truly lost;

5. I have executed this affidavit to report the fact of loss of the said
ATM cash card by Pag-ibig San Fernando Branch, City of San Fernando,
Pampanga and for all other legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

October 9, 2020 at City of San Fernando, Pampanga.

EILEEN PARAS PAULE

Affiant
ID No.___________

SUBSCRIBED AND SWORN before me this October 9, 2020 at City of

San Fernando, Pampanga by affiant, personally known to me, who is the same
person who personally signed before me the foregoing affidavit and
acknowledged that she executed the same.

Doc. No. ;
Page No. ; Notary Public
Book No. ;
Series of 2020.