Republic of the Philippines)

Province of Kalinga)
City of Tabuk) S.S.
AFFIDAVIT OF LOSS

             I, JESSICA W. WANSI, Filipino citizen, of legal age, and currently

residing at Purok 5 Bulanao, Tabuk City, Kalinga, after having been duly sworn
in accordance with law, hereby depose and say:
 
1. That I was issued a PASSBOOK by Bangko Montañosa, Inc. (A Rural
Bank), branch Bulanao, Tabuk City, Kalinga, bearing an account
number 01538347;

2. That I placed the said Passbook in my shoulder bag when I went to

Dagupan;

3. That when I was going home, I noticed that my Passbook was missing;

4. That I tried to find my Passbook, but can no longer be located;

5. That I exerted diligent efforts to find and locate the same but to no
avail;

5. That the said passbook was lost in the manner stated above and not
confiscated not canceled by the issuing agency or any instrumentality of
the government;

6. That I am now executing this this affidavit to attest the truth of the
foregoing narration and for all legal intents it may serve best.
  
 
            IN WITNESS WHEREOF, I have hereunto affixed my signature this
27th day of October 2021 at Bulanao, Tabuk City Philippines.

        

JESSICA W. WANSI
Affiant

            SUBSCRIBED AND SWORN to before me this 27th day of October

2021, by the affiant who personally appeared and presented to me a competent
proof of her identity, the particulars of which are indicated below her name and
signature and that she is the same person who signed the foregoing affidavit
before me and acknowledged that she executed the same.

Doc No. 379

Page No. 76

Book No. XIII

Series of 2021.