REPUBLIC OF THE PHILIPPINES )

__________CITY )

JOINT AFFIDAVIT OF LOSS

We, JENNIFER HERNANDEZ and LOLITA HERNANDEZ, both

of legal ages, Filipinos, after having been duly sworn to in accordance with
law, do hereby deposes and states:

1. That we are the owners of BPI bank booklet, BPI Marulas

Valenzuela Branch under Account No. 000193-3592-72;

2. That sometime on September 22, 2017, at around 3:30 PM,

LOLITA HERNANDEZ lost her wallet containing the said bank booklet
while she was aboard a taxi on her way to SM Valenzuela;

3. That despite diligent efforts exerted, we could no longer locate,

find or recover the said bank booklet, and to the best of our knowledge, the
same is truly lost;

4. That in the event that the lost bank booklet should hereafter be
found or located, we undertake to forward or surrender the same to BPI
Marulas Valenzuela branch for appropriate disposal;

5. That we are executing this Affidavit to attest to the truth of the

foregoing statements and to formally inform BPI Marulas Valenzuela
Branch of the loss of said bank booklet and to have an appropriate
deactivation/disposal of the bank booklet.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________ at _____ City.

JENNIFER HERNANDEZ LOLITA HERNANDEZ

SUBSCRIBED AND SWORN to before me this _____ day of _____

2017 at _____ City. Affiant exhibiting to me their Valid Driver’s License
ID No. 2-88-077943 and Senior Citizen ID No. 2454.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2017