REPUBLIC OF THE PHILIPPINES)

Province of ____________________)

AFFIDAVIT OF LOSS

I, LOURDES DUMANDAN ABANADOR, married, Filipino, of legal age, and

a resident of Kalilayan Ilaya Unisan, Quezon, after having been sworn to in accordance
with law, hereby deposes and states that:

1. That I am a holder of the ARDCI Passbook with CBU- Capital

Build-up issued by ARDCI NGO GROUP, INC.- Unisan, Quezon Branch;

2. On April 2022, I noticed that my CBU- Capital Build-up , was

missing was missing;

3. After going over my personal effects and documents, and

searched all the possible drawers and envelopes where the said passbook might have
been placed but I did not find the same;

4. That despite diligent search and efforts to locate said CBU- Capital

Build-up , I could not find the same, I believe that said CBU- Capital Build-up, is now
lost and beyond recovery; and

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

foregoing facts and to request for a replacement of my CBU- Capital Build-up.

AFFIANT FUTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto set my hands this ____ day of ________,

2022 at _____________________________.

LOURDES DUMANDAN ABANADOR

Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of ________, 2022 at

_____________ City, affiant exhibiting to me her Voter’s ID VIN: 5649-0035A-
B1769LDA20000, bearing his photograph and signature and I hereby certify that I
personally examined the affiant herein and that I am fully satisfied that she voluntarily
executed the foregoing petition and she understood all the allegations herein.

Doc. No. ____; Notary Public

Page No. ____;
Book No. ____;
Series of 2022.