REPUBLIC OF THE PHILIPPINES)

MATAASNAKAHOY, BATANGAS ) S.S.

AFFIDAVIT OF LOSS

I, EMELINDA C. ARIOLA, of legal age, Filipino citizen and a resident

of Camella Homes Phase 1 Block 1 Lot 23, Brgy. Tibig Lipa City, Batangas,
Philippines, after having been sworn to in accordance with law hereby
depose and state that:

1. I am the owner of the of the ATM Card and Passbook with same
bank account number of 9018579289 issued by Rizal Commercial
Banking Corp.

2. That I placed my said ATM Card and Passbook inside my house;

3. That on April 09, 2023, I was at home looking for my ATM Card
along with my Passbook and realized that it was misplaced and/or
went missing;

4. That took diligent search and efforts to locate my ATM Card and
Passbook but I could not find the same, hence, I believe it is now
beyond recovery.

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

foregoing statement, and to request for a replacement of my “ATM
Card” together with my “Passbook” and for whatever legal purpose
it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 12th day

of April, 2023 at Mataasnakahoy, Batangas, Philippines.

EMELINDA C. ARIOLA
Affiant

SUBSCRIBED AND SWORN to before me this 12th day of April, 2023

in Mataasnakahoy, Batangas. Affiant exhibited to his competent evidence of
identity as Passport No. P1354492B.

Notary Public

Doc. No. 189;

Page No. 39;
Book No. II;
Series of 2023.