AFFIDAVIT OF LOSS

 
 
REPUBLIC OF THE PHILIPPINES)
) S.S. 
                                                     
 
I, Jaypee S. Samson, Filipino, of legal age, residing at 95 Bulacan St. Bagong
Barrio, Caloocan city, after having been sworn in accordance with
law hereby depose and state:
 
That I am the true and lawful owner of a Banco De Oro
(BDO) ATM card, more particularly described as follows:
 
CARD NAME: BANCO DE ORO SAVINGS ACCOUNT ATM CARD
ACCOUNT NUMBER: 003000330970

Estimated Date of loss: April 4, 2021

         
That sometime on April 2021, my Banco De Oro (BDO) ATM
card was lost, after spending time looking for it, said BDO ATM card
could not be found;
 
          That I exerted best efforts to look for said Banco De Oro
(BDO) ATM card but to no avail;
 
          That I am executing this affidavit to attest to the truth of the
foregoing and to request from Banco De Oro, to
invalidate/cancel/revoke the BDO ATM card that was lost and to
issue a replacement of the same.
 
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of
_______________. 20___ at _________________________.
 
                  
                   
                                                                      
Jaypee S. Samson
         Affiant
 
         
SUBSCRIBED AND SWORN to before me, this ____ day of
______________, 20___ in ___________________ City, with affiant exhibiting
his/her _______________________________,
Issued on ________________________ at _______________________,
Philippines.
 
 
 

Doc.  No. :  ________;

Page  No. :  ________;
Book No. :  ________;
Series of 20_______.