You are on page 1of 1

REPUBLIC OF THE PHILIPPINES )

CERTIFICATION OF NON-RECEIPT OF STOCK DIVIDEND

I, Lilia Alegre Manzano, Filipino, married, of legal age, with residential/postal address at
No. 13 Highland Drive Blue Ridge, Quezon City, after having duly sworn to in accordance with law,
depose and state that:

I am A registered stockholder of (BDO UNIBANK, INC.).

To date, I certify that I have not received nor have I authorized any person to receive the
following stock dividend which is deemed lost:

Certificate No. No. of Shares Date


_________ _______ ____ ____________
__________ _ ___________ ____________
___________ ___________ ____________
___________ ___________ ____________

I further certify that I have not sold nor have authorized any person to sell any of the aforesaid
stock certificate or partial shares thereof.

I have requested BDO Unibank, Inc. for the replacement of the of the above certificate and in
the process I have also authorized the stock transfer agent, Stock Transfer Service, Inc. to cancel
the lost certificate.

If the negotiation of the original certificate was due to my negligence or with my consent or
authority, I shall surrender the new certificate and shall pay all the expenses incurred by BDO,
Unibank, Inc. in the cancellation of the alleged lost certificate and the issuance of the new
certificate.

Upon receipt of the new certificate , I hereby agree to the release of BDO Unibank, Inc. and its
officers and employees from any claims or liability of costs, damages arising from or in
connection with the issuance of the original as well as the replacement certificate.

I am executing this affidavit to attest the truth of the foregoing statements and to request BDO
Unibank, Inc. to replace the lost stock certificate.

IN WITNESS WHEREOF, I, hereunto set my hands this________day of_________________2018__at


_______________________________.

_____________________________
Lilia A. Manzano

You might also like