Republic of the Philippines)

City of Zamboanga )S.S.

x-------------------------------x

AFFIDAVIT OF LOSS
I, JESSIE M. TUMACMOL, of legal age, Filipino citizen and a
permanent resident of Barangay Pianon, Municipality of Kalawit,
Zamboanga Del Norte, Philippines, after having been duly sworn to in
accordance with law, hereby depose and say that:

1. I am a holder of an ATM card duly issued by the Land Bank of the

Philippines, Municipality of Liloy, Zamboanga Del Norte;

2. While I was looking for the said ATM Card today, I could not find
it. The ATM Card got lost together with my other documents that I
was carrying while I was travelling from the Municipality of Kalawit
to Zamboanga City;

3. I exerted all efforts to locate the said ATM card but the same can
no longer be found;

4. For all intents and purposes, I am now declaring the above-

mentioned Landbank ATM card lost and beyond recovery;

5. Furthermore, I am executing this Affidavit to attest to the truth of

the foregoing facts and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this

_________________ at Zamboanga City, Philippines.

JESSIE M. TUMACMOL
Affiant
SSS 10-0239950-1

SUBSCRIBED AND SWORN to before me this

______________________ at Zamboanga City, Philippines. Affiant swore to
the truth of the foregoing.

Doc. No.______
Page No._____
Book No._____
Series 2022