Republic of the Philippines}

City of Cebu } S.s

AFFIDAVIT OF LOSS

I, ARCHIMEDES VASQUEZ, of legal age, Filipino, single and a resident of Pajo,

Lapu-Lapu, City, after having been duly sworn to in accordance with law, depose and state:

1. That I am a holder of Automated Teller Machine (ATM) Card No. 12345678 duly
issued in favor by Banco de Oro Unibank, Inc. on January 12, 2010 in Cebu City;
2. That I used to put said ATM card in my wallet;
3. That sometime on July 20, 2010, when I arrived home from work, I discovered that
said ATM card was no longer in my wallet;
4. That diligent effort to locate the same proved futile;
5. That in view thereof, I now desire and hereby request BDO to issue another ATM card
in lieu of the lost one;
6. That I bind myself to save BDO harmless from any loss or damage that it may incur in
connection with the issuance of a new ATM card in lieu of the lost one;
7. That I am executing this affidavit to attest to the foregoing facts and for any legal
purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 21 st day of October 2021in
Cebu City, Philippines.

ARCHIMEDES VASQUES
Affiant

SUBSCRIBED AND SWORN TO before me this 21st day of October 2021 in Cebu
City, Philippines, affiant exhibiting to me his valid proof of identification

Doc. No. ____

Page No. ____
Book No. ____
Series of 2021