Republic of the Philippines)

City of Cebu…………………) S.c.

AFFIDAVIT OF LOSS

I, JOJO F. MOLIJON, of legal age, Filipino, married and a

resident of Montealegre, Tuburan, Cebu, after having been duly
sworn to in accordance with law, do hereby depose and state that—

1. I am a holder of Automated Teller Machine (ATM) Card issued

by the Landbank of the Philippines;

2. Said ATM Card has been issued to me in relation to my

membership for the 4P’s by the government;

3. Recently, I went to Asturias, Cebu for purposes of buying some

important stuff for my family;

4. When I reached Asturias, I noticed that my wallet was no

longer inside my pocket;

5. I exerted much effort in order to locate the same but proved

futile;

6. Inside my wallet were my important identification cards,

including that ATM Card issued by the aforesaid bank;

7. I am executing this Affidavit to attest the truthfulness of the

foregoing, and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 22nd day of March 2021 in the City of Cebu, Philippines.

JOJO F. MOLIJON
Affiant
Valid ID: DSWD ID

SUBSCRIBED AND SWORN TO before me this 22nd day of

March 2021 in the City of Cebu, Philippines.

Doc. No. 6
Page No. 2
Book XIV
Series of 2021