REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF LINGAYEN ) S.S.

PROVINCE OF PANGASINAN )

AFFIDAVIT OF LOSS
I, JOCELYN DELA CRUZ ESTRELLA, Filipino, of legal age, and a resident of Solis
Street, Brgy. Poblacion, Lingayen, Pangasinan, after having been sworn to in accordance with
law, do hereby depose and say;
1. That I am a depositor of the Philippine Business Bank, Lingayen Branch, with
passbook account number 127-00-000266-6;
2. That I used to keep the said passbook in my wallet;
3. That in the morning of February 23, 2022, I went to St. Joseph Drug Store Bugallon to
buy medication;
4. That when I left the drug store and as I boarded the tricycle, I realized that my wallet
was missing;
5. That I went back to the said drug store and managed to find my wallet;
6. That when I looked into my wallet, my passbook was nowhere to be found;
7. That I exerted due diligence to locate the same, but to no avail, hence I have
considered it to be lost and beyond recovery,
8. That I now request the Philippine Business Bank to issue a new Passbook/Certificate
in lieu of the lost one and I bind myself to surrender the lost Passbook/Certificate
in the event that the same is found and/or located,
9. That I am executing this affidavit to attest to the foregoing facts, and for all legal
purpose it may serve me.
FURTHER, AFFIANT SAYETH NAUGHT.

JOCELYN DELA CRUZ ESTRELLA

Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of February, 2023 by affiant
who exhibited to me her Philippine Driver’s License with ID No. A07-22-302803, to expire on
2027/01/26 to be the same person who presented and personally signed before me this affidavit
of loss and attested that the contents thereof are true and correct; and that she voluntarily
executed the same.

Doc. No.__
Page No.__
Book No.__
Series of 2023.