REPUBLIC OF THE PHILIPPINES )

CITY OF MALABON )S. S.

AFFIDAVIT OF LOSS

I, XXX, twenty-one (21) years old, single, presently residing at

No. 203 Governor Pascual Drive Barangay Catmon, Malabon City, after
having been duly sworn to in accordance with law, deposes and states that:

1. I am a holder of BDO ATM/DEBIT CARD issued by

Banco De Oro, Caloocan Branch;

2. On March 10, 2019, after attending the Sunday Service at

Jesus Christ is Saviour Church at Malabon, I noticed that
my wallet containing various cards and money including
my ATM/DEBIT Card, was missing;

3. Efforts were exerted to look for my ATM CARD but the

same cannot be found anymore;

4. I am executing this affidavit to attest the veracity of the

foregoing statements of fact for whatever legal purpose,
and other intents this affidavit may duly serve.

IN WITNESS WHEREOF, I have hereunto affix my signature this 19th

day of March 2019, in the City of Malabon, Philippines

XXX
Affiant

SUBSCRIBED AND SWORN TO before me on this 19th day of March

2019. Affiant exhibiting to me his PHILHEALTH ID with No.

NOTARY PUBLIC