REPUBLIC OF THE PHILIPPINES)

CITY OF TAGBILARAN) S.S.

AFFIDAVIT OF LOSS

I, CLEMENTE A. SARTE, Filipino, of legal age, married and a resident of

Vallehermoso, Carmen, Bohol, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am a regular client and a holder of the ID SAVINGS, TWO (2)

PASSBOOKS for LOAN and SAVINGS, and all records of CITY SAVINGS BANK
Tagbilaran City, Bohol;

2. That sometime on March 2, 2020, a fire broke out and consumed our
entire residenial house, including the said ID SAVINGS, TWO (2) PASSBOOKS for
LOAN and SAVINGS, and all CITY SAVINGS BANK records;

3. That said ID SAVINGS, TWO (2) PASSBOOKS for LOAN and

SAVINGS, and all CITY SAVINGS BANK records are not in the hands of any third
person or authority for value or consideration for any purpose whatsoever;

4. That I am executing this affidavit to attest to the fact of loss of said ID

SAVINGS, TWO (2) PASSBOOKS for LOAN and SAVINGS, and all CITY SAVINGS
BANK records for the re-issuance of the same, and for whatever legal purposes this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of March

2020 in Tagbilaran City, Bohol, Philippines.

CLEMENTE A. SARTE
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of March 2020 in

Tagbilaran City, Bohol, Philippines.

ATTY. ADELINE L. GLOVASA

CASILAN LAW AND REALTY
3A CPG Ave., Tagbilaran City
NOTARY PUBLIC UNTIL DECEMBER 31, 2020
PTR No. 7683943; November 26, 2019; CY 2020
NCS No. 2019-33; TIN 312-875-360-000
IBP Membership No. 107324; Jan. 10, 2020
Roll No. 67526; May 24, 2017
MCLE Compliance No. VI-0006667, Valid until April 14, 2022
For the City of Tagbilaran and Other Municipalities of Bohol