REPUBLIC OF THE PHILIPPINES)

CITY OF TAGBILARAN                      ) S.S.

x-------------------------------------x
  
AFFIDAVIT 

        I, JONITH PIGTE of legal age, Filipino, and a resident of Haguilanan, Catigbian, Bohol,
Philippines, after having been duly sworn to in accordance with law, depose and state:

1. That I am an insurance policy holder of Generally Life Insurance having a policy number
PN-S-72056903-8-1;

2. That on November 1, 2016 I paid a premium of TWENTY-NINE THOUSAND FIVE

HUNDRED SIXTY-TWO to FE MALALIS an employee of BDO Tagbilran;

3. That FE MALALIS assured that she will deposit the said money to BDO as a premium of
my insurance;

4. That to my surprise, I found out that the money I gave to her was not deposited as what
we agreed;

5. That when I asked the BDO Tagbilaran Branch on what is my recourse and remedy they
advised me to make an affidavit;

6. That it is my intention to claim the above-mentioned amount which was misappropriated

by FE MALALIS;

7. That I execute this affidavit voluntarily to attest to the truth of the foregoing statements to
support my insurance claim, and for all legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this 4TH of September 2018
in the City of Tagbilaran, Province of Bohol, Philippines.

JONITH PIGTE
Affiant
DL. No. ___________
Issued by LTO

SUBSCRIBED AND SWORN to before me this ________________ in the City of Tagbilaran,

Bohol, Philippines. Affiant exhibited to me his competent proof of identity previously written.

Doc. No. ________;

Page No.________;
Book No.________;
Series of 2018.