REPUBLIC OF THE PHILIPPINES)

CITY OF TACLOBAN ) S.S.

x------------------------------------------------x

AFFIDAVIT OF LOSS

I, FRANCIS B. NAVARRO, of legal age, Filipino, single and a resident of BRGY. CALOGCOG
TANAUAN LEYTE, 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. 5367 8902 9764 0005 and with account
# 122200010645 duly issued in my favor by BANK OF COMMERCE, Tac. Branch last October, 2019 in
Tacloban City.

2. That I used to put said ATM card in my wallet;

3. That sometime on December 3, 2023, 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 Bank of Commerce to issue another ATM card in
lieu of the lost one;

6. That I bind myself to save Bank of Commerce 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 4th day of December, 2023 in
Tacloban City, Philippines.

FRANCIS B. NAVARRO
Affiant
Voter's ID No. 3748-0069A-A2675FBN

SUBCRIBED AND SWORN TO before me this 4th day of December, 2023 in Tacloban City,
Philippines, affiant exhibiting to me his valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.