Republic of the Philippines)

DONE:In the City of Tabuk, Kalinga, Philippines)S.S.

AFFIDAVIT OF LOSS

I, RENEE T. DANGGIS, of legal age, single, Filipino citizen and with residence
Barangay Poblacion, Lubuagan, Kalinga, Philippines, after having been duly sworn to in
accordance with law hereby depose and state that;

1. I am the owner of a LANDBANK ATM card.

2. It has been my long practice to place the card inside my wallet for safe keeping;

3. On February 17, 2021, after travelling from Malibcong, Abra to Lubuagan,

Kalinga, I discovered that my wallet containing the said card is missing.

4. Despite efforts made to look for my wallet and inquiries to members of our
household, the same proved futile, hence I considered it lost and beyond point
of recovery;

5. The above-mentioned ATM card was not confiscated for violations of any rules
and regulations pertaining to its use neither was it delivered to a third person to
guarantee the satisfaction of an obligation of whatever nature;

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

the foregoing declaration and to support my request for the re-issuance of
another ATM card in lieu of the lost one.

IN WITNESS WHEREOF, I have hereunto affix my signature this 19 th day of February

2021 at Tabuk City, Philippines.

RENEE T. DANGGIS
Affiant

SUBSCRIBED AND SWORN TO BEFORE me this 19th day of February 2021 at

Tabuk City, Philippines. Affiant personally appeared and known to me to be the same person
who acknowledged to me that the same is his free and voluntary act and deed.

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