REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI
) S.S.
x-------------------------------------x
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
Affiant
Voter's ID
No. 5555
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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.
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