REPUBLIC OF THE PHILIPPINES )

CITY OF DUMAGUETE ) S.S.

AFFIDAVIT OF LOSS

I, Mark Jelou A. Renegado, of legal age, Filipino citizen, and a resident of

Tayasan, Negros Oriental, under oath, hereby depose and state that:
1. That I am a holder of the BDO debit card with account number ending
with 1234 issued by BDO Silliman Campus Branch.
2. That on September 11, 2023, Monday, I traveled to school using a
motorcycle while my wallet containing the said BDO debit card was
in my pants pocket. When I arrived, I realized that my wallet fell off
from my pocket while riding.
3. That I went back to where I came from to search for my wallet on the
same day but despite of diligent search and efforts, I could not find it
and I now believe that it is now lost beyond recovery;
4. That I am executing this affidavit to attest to the truth of all of my
statement and in order to support my application to replace the lost
one.
IN WITNESS WHEREOF, I have affixed my signature this 18th day of
September 2023, at Dumaguete City, Philippines.

Mark Jelou A. Renegado

Affiant

SUBCRIBED AND SWORN to before me this 18th day of September

2023, affiant exhibiting to me his school ID no. 22-01-01466 issued on August
2022 at Silliman University.
WITNESS MY HAND AND NOTARIAL SEAL on the day, year, and
place first above-written.

Atty. Annievin A. Hawk

Notary Public for City of Dumaguete
Commission Serial No. xxxxxx until xxxx
Bagacay, Dumaguete City
Roll of Attorney No. xxxxxx
PTR No. xxxxxx/issued at xxxx/on xxxx
IBP NO. xxxxxx/date/place
Doc. No.____
Page No.____
Book No.____
Series of (year)