Republic of the Philippines )

Davao City ) S.S

AFFIDAVIT OF LOSS

I, Jenny Mae Oclarit, of legal age, single, and a resident of Riverside Purok 4,
Lower Jasaan, Jasaan, Misamis Oriental, after having been sworn to in accordance with
law, do hereby depose and say that:

1. I am the owner of a Metrobank ATM CARD (“ATM Card” for brevity) of

Account number No. 5049460375203229

2. Yesterday afternoon, I went to an ATM machine somewhere in downtown area

of the City to withdraw cash;

3. To my surprise, said ATM Card as not in my wallet wherein I usually put it;

4. Hence, I immediately went back to our staffhouse in Biaong, Davao City to

look for the same but it could not be found;

5. I took diligent efforts to look for my ATM Card but to no avail;

6. I am executing this affidavit to attest to the truth of the foregoing and to request
another Metrobank ATM Card.

IN WITNESS WHEREOF, I hereunto affix my signature this 28 th day of October 2019 at

Davao City.

Jenny Mae Oclarit

Affiant

SUBSCRIBED AND SWORN to me this 28th day of October 2019 at Davao City, affiant
exhibiting to me her United Multi-Purpose ID numbered 0111-8344009-4.

Doc No.: _____

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Book No.: _____
Series of 2019