AFFIDAVIT OF LOSS

I, ROBERT KANE M. REYES, Filipino, of legal age, single and a

resident of Isulan, Sultan Kudarat, Philippines, after having duly sworn to
in accordance with law, hereby depose and say that:
1.
I am the holder of an Automated Teller Machine
card number 6863440 under Account No.649050695w issued
by Banko de Oro;
2.
The credit balance of this account is Php 8,000
as of June 19 , 2006;
3.
I lost said ATM on June 22, 2006 and that I
exerted all efforts to locate the same but I could not remember
exactly where I placed/left it and it is considered lost for all
legal purposes;
4.
The money represented by the balance to the
credit of the account is my personal property and that I have no
assignment, transfer or pledge thereof
5.
Said ATM Card was not confiscated by any
officer of the law or the officers of Banko de Oro by reason of
any violation of any law, ordinance, presidential decree or rules
and regulation of said bank; and neither was it offered as
collateral for any loan;
6.
I am executing this affidavit to attest to the
foregoing facts and for the purpose of securing the issuance to
me of a replacement ATM card in lieu of the one that was lost;
7.
That I hereby agree to hold the (name of bank)
its officers and employees, free and harmless and to indemnify
it/them for any loss that it/they may sustain by issuing another
ATM Card;
IN WITNESS WHEREOF, I have hereunto set my hand this June 23, 2006 in the
City of Tacurong, Philippines.
_______________
Affiant

SUBSCRIBED AND SWORN to before me this June 23, 2006 in the City of
Tacurong Philippines, affiant having exhibited to me his community tax
certificate with no.53589 issued on 02-05-06 at Isulan, Sultan Kudarat.

Doc. No.____;
Page No.____;
Book No.____;

Series of 2006.

Legal Research and Writing

LAW 106

Submitted by:
Robert Kane M. Reyes

Submitted to:
Atty. Dagum