REPUBLIC OF THE PHILIPPINES )

DASMARIÑAS CITY, CAVITE ) S.S.

AFFIDAVIT OF LOSS
I, ERNIE SOMIDO SENAR, of legal age, Filipino Citizen, and with postal and residence
address at Block 17 Lot 5 Phase 2, Solar Homes, San Agustin II, Dasmarinas City, Cavite, after
having been duly sworn to in accordance with law, hereby depose and say:

That I am a bonafide member of CARD SME Bank whereas they issued an Passbook;

That the said Passbook was misplaced/ lost;

That despite of diligent efforts, the said Passbook cannot be found and considered as lost;

That I am executing this affidavit to attest to the truth of the foregoing facts for all legal
intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of May 2022 at
Dasmarinas City, Cavite, Philippines.

ERNIE SOMIDO SENAR

Affiant

SUBSCRIBED and SWORN to before me on the date and place above-written, affiant
exhibiting to me his/her Philhealth No. 08-200873158-2.

Doc. No. 182

Page No. 36
Book No. 09
Series of 2022