REPUBLIC OF THE PHILIPPINES )

PROVINCE OF SURIGAO DEL NORTE)S.S.

CITY OF SURIGAO )

AFFIDAVIT OF LOSS

I, MARIANNE GARCIA ABRIA, of legal age, Filipino, a resident of

Purok 2, Brgy. Rizal, Surigao City, Surigao del Norte, after having been
duly sworn to according to law hereby depose and state:

That I am a holder Automated Teller Machine (ATM) issued by Asia

United Bank Corporation (AUB), Surigao City branch;

That however, the said ATM was lost while in my possession;

That I have made a diligent search and inquiry to locate the lost
ATM but to no avail, it is irretrievably lost and cannot be located;

That the loss of the said ATM was not due to any negligence, willful
act, or omission on my part;

That I am executing this affidavit to attest to the truthfulness of

the foregoing facts and circumstances and for whatever legal purpose/s
it may serve best;

IN WITNESS WHEREOF, I have hereunto set my hand this 11 th day

of August, 2023 at Surigao City, Surigao del Norte.

MARIANNE GARCIA ABRIA

Affiant

SUBSCRIBED AND SWORN to before me this 11th day of August,

2023 at Surigao City, Surigao del Norte, Philippines.

DOC NO. _____;

PAGE NO. _____;
BOOK NO. _____;
SERIES of _____.