REPUBLIC OF THE PHILIPPINES)

__________________________________) S.S.

AFFIDAVIT OF DENIAL

I, _______, of legal age, Filipino citizen, married and a resident of _______,

after being sworn in accordance with law, hereby depose and state that –

1. I submitted a loan application with the Land Bank of the

Philippines;

2. During the credit investigation, I was informed by the Land Bank

of the Philippines that their system showed that there is an existing loan with
Asia Trust Development Bank (ATB) Head Office under the name of a certain
“_______;

3. The aforesaid person with existing loan bears the same first name
and last name as mine;

4. I am thus executing this affidavit to attest that I am not the person

who appeared to have contracted a loan with Asia Trust Development Bank
(ATB) Head Office;

5. Further, I am executing this affidavit to deny that I and the person

_________” which appeared in the records of the credit investigation team are
the same;

6. Finally, I am executing this affidavit to attest the truth and veracity

of the foregoing statements and for all legal intents and purposes it may serve;

7. Affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____at

____.

Affiant

SUBSCRIBED AND SWORN to before me, this ______ at ______, affiant

exhibiting to me her ID bearing her photograph and signature as competent
evidence of her identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.