REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) S.S

AFFIDAVIT OF LOSS
KNOW ALL MEN BY THESE PRESENTS:

I, GLORY CHRIST E. MANLUCOB, Filipino, of legal age, single and a resident

of Poblacion, Bislig City, Surigao del Sur, after having sworn and according to law,
hereby depose and state that:

1. I am the owner of an Automated Teller Machine (ATM) card of

Development Bank of the Philippines (DBP) with account number
__________________ duly issued by DBP Bislig City.

2. I have recently discovered that said card is irretrievably lost and can
no longer be found despite diligent efforts to locate the same.

3. I execute this affidavit to attest to the truth of the foregoing and

whatever legal purposes it may serve best.

IN WITNESS WHEREOF, I have here unto set my hand this ____ day of
_____________ in the City of Bislig, Province of Surigao del Sur.

GLORY CHRIST E. MANLUCOB

Affiant

SUBSCRIBED AND SWORD to before me this ____ day of _____________ at

Bislig City, Province of Surigao del Sur.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2020.