Republic of the Philippines)

) S.S.

Affidavit Of Loss Of ATM Card

         I, __________________, of legal age, Filipino, single and a resident of ____________________, after
having been duly sworn to in accordance with law, depose and state:

1. That I am a holder of Automated Teller Machine (ATM) Card No. _____________ duly issued
in my favor by ___________________. on ____________________ in _____________;

2. That I used to put said ATM card in my wallet;

3. That sometime on _____________, when I arrived home from work, I discovered that said
ATM card was no longer in my wallet;

4. That diligent effort to locate the same proved futile;

5. That in view thereof, I now desire and hereby request BDO to issue another ATM card in
lieu of the lost one;

6. That I bind myself to save BDO harmless from any loss or damage that it may incur in
connection with the issuance of a new ATM card in lieu of the lost one;

7. That I am executing this affidavit to attest to the foregoing facts and for any legal purpose
it may serve.

         IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of July 2021 in
Makati City, Metro Manila, Philippines.
          

_________________
Affiant
    SUBCRIBED AND SWORN TO before me this _______________ in ___________, , Philippines,
affiant exhibiting to me his valid proof of identification issued by ________________ with ID
number ________________ issued on______________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 20___.