AFFIDAVIT OF LOSS

Republic of the Philippines)

Province of Cavite) S.S.)
Gen. E. Aguinaldo, Cavite
x---------x

I, ABRIAN R. BARQUILLA, of legal age, Filipino, married and with present

residence and postal address at A. Mabini Street, Brgy. Poblacion II, Gen.E.
Aguinaldo, Cavite after being duly sworn to in accordance with law, hereby
depose and state:

That I am have in my possession a GLOBE GCASH ATM which is validly

issued under my name;

That I regularly use it for my banking transactions such as deposit and

withdrawal;

That sometime last week, my wallet was lost in our house in Gen. E.
Aguinaldo, Cavite where all my government identification cards were placed
including the GCASH ATM;

That despite diligent search and efforts, I could not find it such that I
honestly believe that it is now beyond recovery;

That I am executing this affidavit in good faith and without any intention to
defraud or deceive;

As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and for other reliefs as may be just and equitable;

IN WITNESS WHEREOF, I have hereunto set my hand this 27th day

of November 2017 at Gen. E. Aguinaldo, Cavite, Philippines.

ABRIAN R. BARQUILLA
AFFIANT
ID PRESENTED: COMPANY ID 063126

SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public for and

in the Province of Cavite this 27th day of November 2017. Affiant personally
came who is known to me as the same person who signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of
the contents of said instrument.

Doc. No.______
Page No. ______
Book No. _____
Series of 2017