REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI ) S.S.
AFFIDAVIT OF LOSS
I, GERARDO L. TAN, of legal age, Filipino, single and a resident of 2222 Washington Street, Pio del Pilar, Makati 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. 123456789 duly issued in my favor by Banco de Oro Unibank, Inc. on January 12, 2010 in Makati City;
2. That I used to put said ATM card in my wallet;
3. That sometime on July 20, 2013, 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 29th day of July 2013 in Makati City, Metro Manila, Philippines.
GERARDO L. TAN
Voter's ID No. 5555
SUBCRIBED AND SWORN TO before me this 29th day of July 2013 in Makati City, Metro Manila, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.