I, _____, of legal age, Filipino, and resident ________________, Cebu City, Philippines,

hereby depose and say:

1. That I am the lawful owner of _____ card, ______, and ______ card;
2. That the said enumerated items were lost sometime around ___ of this year,
2023;
3. That upon meticulous scrutiny of my living space and office desk, on numerous
occasions, such ATM and identification cards could not be found;
4. Hence, I have resigned to the fact that those items are irretrievably lost and
cannot be recovered.
5. That the said items are not due to any negligence, willful act, or omission on my
part.
6. That I am executing this Affidavit of Loss to attest to the foregoing facts and for
the purpose of applying for the issuance of new replacement cards.

IN WITNESS WHEREOF, I have hereunto affix my hand this 18th day of September
2023 in Cebu City, Philippines.

__________________
Affiant
Passport No.

SUBSCRIBED AND SWORN to before me this __th day of _______ 2023 in

Cebu City, Philippines, affiant exhibiting competent evidence of identity through [type of
card] with ID no. ________ , issued on _______ .

WITNESS MY HAND AND SEAL.

Doc. no. ___ Notary Public

Page no.___
Book no. ___
Series of ___