Republic of the Philippines)

City of Cebu ) s.s.

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

AFFIDAVIT OF LOSS

I, ___________(name) _______, Filipino, of legal age, single and a resident of

____________ , ___________ Philippines, after being duly sworn in accordance with
law, depose and state:

1. That I am a depositor of Bank of the Philippine Islands (BPI) as such I was duly
issued with an Automated Teller Machine (ATM) card by the said bank;
2. That I had been constantly using the said ATM card until very recently (or
when did he stop using it) when I noticed that the same was no longer in the
wallet where I usually kept it;
3. That it I tried to find my BPI ATM card in all of my things in our house as
well as in my office but the same could not be found;

4. Efforts were exerted to locate the said ATM card , but in spite of diligent search,
it could not be found and the same is now beyond recovery;

5. As such, I am executing this Affidavit to attest to the foregoing facts and to

support my application for replacement of my BPI ATM card in lieu of the lost
one and for whatever purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __________ day of 2018 at
Cebu City, Philippines.

_______(name) _________
Affiant

SUBSCRIBED AND SWORN to before me, this _______ day of 208 at Cebu City,
Philippines., Affiant who is personally known to me (or whom I have identified
through competent evidence of identity) and who exhibited his _________(valid ID
details )_________________

Doc.No ._______
Page No. _______
Book No. ______
Series of 2018