LETTER OF INSTRUCTION

Date:_____________

Sir/Madam:

We hereby request the

Cash Card Replacement

Value Transfer

for Mr./Ms. _____________________ __________________________ . Please see details below:

REASON captured

damaged

lost / stolen

defective

others, pls. specify ____________________________________________________

FOR VALUE TRANSFER ONLY:

SOURCE Old Card Number ____________________________________________________

AMOUNT Remaining balance  Specific amount
DESTINATION New Card Number ____________________________________________________
Others, pls. specify ____________________________________________________

Company Card Holder Authorized Signatory/ies

Signature over printed name Signature over printed name*

*By signing on the space provided, the COMPANY certifies that the Cardholder’s signature
appearing hereon is genuine and belongs to the person from whom it purports to be. In this
connection, COMPANY hereby unconditionally and irrevocably agrees to keep free and
indemnify BDO from and against any and all liabilities, actions, claims, suits and/or damages
of whatever kind or nature that BDO may face, suffer or incur arising from or in connection with
its reliance thereon.

DECLARATION OF LOSS
(For LOST CARD with balance of P20,000 and below)

I, ____________________________________________ married/single, of legal age, now residing at

_________________________________________________ after being duly sworn in accordance with law, do
hereby depose and say:

That I am the lawful holder of the Cash Card with card number ____________________________;
That I am the rightful owner of the funds therein and the same is not assigned, conveyed, or ceded in favor of a
third party;
That the Cash Card has been lost/stolen/destroyed under the following circumstances: __________________
_______________________________________________________________________________________;
That a diligent search for card has been unsuccessful;
I hereby agree to hold Banco De Oro, its assigns, officers and employees free and harmless from liability and to
indemnify them for any loss or damage they may suffer as a consequences of the eventual delivery to me of the
proceeds of the said amount
This affidavit is executed to attest to the truth of all foregoing statements and to serve as a basis that the above
mentioned account be immediately closed and a new one be opened.
That I am willing to testify in any court of justice to substantiate the truth and veracity of each and all the foregoing
facts;
That this Declaration will serve as my unqualified undertaking to hold the Bank free and harmless from any loss or
liability of whatever nature that it may incur or stand to incur by reason of or as consequence of acceding to my
request including but not necessarily limited to the obligation to honor in the hands of a holder in due course the
Subject said to be lost, destroyed or stolen.
That I undertake to surrender Subject to the Bank for proper disposition in the event that the same should be
found and located.

__________________________________
Affiant Signature Over Printed Name
 AFFIDAVIT OF LOSS
(For LOST CARD with balance of more than P20,000)

REPUBLIC OF THE PHILIPPINES ) S.S.

MAKATI CITY, METRO MANILA

I ( the “Affiant” ) ____________________________________________ married/single, of legal age, now

residing at _________________________________________________ after being duly sworn in accordance with
law, do hereby depose and say:

That I am the lawful holder of the Cash Card ( the “Subject” ) with card number
_______________________________________;

That I am the rightful owner of the funds therein and the same was not assigned, conveyed, or ceded in favor of
a third party;

That the Cash Card has been lost/stolen/destroyed under the following circumstances: __________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________;

That a diligent search for card has been unsuccessful;

I hereby agree to hold Banco De Oro, its assigns, officers and employees free and harmless from liability and to
indemnify them for any loss or damage they may suffer as a consequence of the eventual delivery to me of the
proceeds of the said amount;

This affidavit is executed to attest to the truth of all foregoing statements and to serve as a basis that the above
mentioned account be immediately closed and a new one be opened.

That I am willing to testify in any court of justice to substantiate the truth and veracity of each and all the
foregoing facts;

That this Affidavit will serve as my unqualified undertaking to hold the Bank free and harmless from any loss or
liability of whatever nature that it may incur or stand to incur by reason of or as consequence of acceding to my
request including but not necessarily limited to the obligation to honor in the hands of a holder in due course the
Subject said to be lost, destroyed or stolen;

That I undertake to surrender Subject to the Bank for proper disposition in the event that the same should be
found and located.

IN WITNESS WHEREOF, I have set my hands at ___________________________, Philippines, on this day

of ____________ , ___________.

___________________________________
Affiant Signature Over Printed Name

Signed in the Presence of:

___________________________________ _________________________________

SUBSCRIBED AND SWORN to before me this _______ day of ________, ________ in

__________________, Philippines, affiant exhibited his/her Community Tax Certificate No.
________________________________ issued in _________________________ on ______________,
__________ .

NOTARY PUBLIC
Until ____________________

Doc. No. _______________

Page No. _______________
Book No. _______________
Series of ________________