Republic of the Philippines)

City of Davao )S.S.

x------------------------------------x

AFFIDAVIT OF LOSS

I, NELSON P. JAPSON, of legal age, Filipino, single, and a

resident of Blk. 08, Lot 01, Dinaville Subd., Maa, Davao City,
after having been duly sworn in accordance with law, hereby
depose and say that:

1. I am the person who caused the execution of this

affidavit;

2. I am a holder of a Union Bank Plaza (1005) ATM under

account number 00000000109817437149 which was
issued on December 17, 2019.

3. Sometime on December 2020, I unfortunately lost the

said ATM while my house was undergoing repair and
renovation. I surmise that the said ATM was inadvertently
thrown away together with other garbage while I was
cleaning our house.

4. I exerted due diligence and persistent efforts in locating

the said ATM but to no avail and I now consider the same
as irretrievably lost;

5. I am executing this Affidavit to attest to the truth and

veracity of all the foregoing and for whatever legal
purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this ______________at Davao City, Philippines.

NELSON P. JAPSON
Affiant
SSS No. 09-1159850-4

SUBSCRIBED AND SWORN to before me this

_______________ at Davao City, Philippines. For purposes of
evidence of identity, affiant exhibited to me his identification
document as indicated above.

Doc No. ___;

Page No. ___;
Book No. ___;
Series of 2021.