AFFIDAVIT 

OF LOSS

I, THOMAS G. FEDERER, Filipino, of legal age, married, and with

residence at Unit 2345 Tower 1 Green 2 Residences, Brgy. Burol Main, Dasmariñas
City, Cavite, after being duly sworn to in accordance with law, hereby depose and
state that:

1. I am a holder of ATM card for Chinabank Payroll with account number

1324379574232;
2. The said ATM card was lost while moving in to our present home address
last December 20, 2022;
3. Despite diligent search and efforts to locate it, it has been lost and cannot be
found;
4. As such, I believe that it is now beyond recovery; and
5. I am executing this Affidavit to attest to the truth of the foregoing and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 25 th of March 2023

in Mandaluyong City, Philippines.

THOMAS G. FEDERER
Affiant

SUBSCRIBED AND SWORN TO before me on the above-mentioned date

and place, the affiant exhibited to me his Passport P13290324945 as his competent
evidence of identity.
 
NOTARY PUBLIC

Doc No. ;
Page No. ;
Book No. III;
Series of 2023.