REPUBLIC OF THE PHILIPPINES)

TARLAC CITY )S.S.

AFFIDAVIT OF LOSS

I, CLAIRE MARIE EUNICE C. TAUMO, of legal age, and a resident of Block 7,

Tibag Tarlac City, after having been duly sworn to in accordance with law, do hereby
depose and say, to wit:

1. That I am a holder of a Passbook issued by Philippine Rural Bank, Angeles

Branch;

2. That on October 2019 the above-said Passbook was lost/went missing;

3. That recently, despite diligent efforts exerted to locate the same, it could no
longer be found and is now deemed lost and beyond recovery;

4. That I am executing this affidavit to attest to the truth of the foregoing statements
and facts.

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 26 th day of

January 2021, at Tarlac City, Philippines.

ROSCELLE P. VENTURA
Affiant

SUBSCRIBED AND SWORN to before me this January 26, 2021, at Tarlac City,
Philippines.

Doc. No. _______;

Page No. _______;
Book No. ______;
Series of 2021.