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REPUBLIC OF THE PHILIPPINES)

TARLAC CITY ……………………) S.S.

AFFIDAVIT OF LOSS

I, JEFFREY MAGNO, Filipino, of legal age, married and a resident of Tarlac City,
after having been duly sworn to in accordance with law do hereby depose and state:

1. That I am a casual employee of the Provincial Government of Tarlac assigned at


the Provincial Jail’s Office;

2. That as such I was issued an ATM Card with Savings Account by the Land Bank
of the Philippines, Tarlac branch, the ATM No. of which is I could no longer be
remembered;

3. That sometime on May 20, 2017, after I took my salary said ATM Card was
misplaced by me;

4. That I exerted all necessary efforts to locate it, but the same could no longer be
found;

5. That I am executing this affidavit to inform the Land Bank of the Philippines,
Tarlac branch and or proper authorities about the situations for possible
retrieval/replacement of the same and for whatever legal purpose this affidavit
may duly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 24 th day of May 2017 at
Tarlac City, Philippines.

JEFFREY MAGNO
Affiant

SUBSCRIBED AND SWORN to before me this 24 th day of May 2017 at Tarlac City,
Philippines by JEFFREY MAGNO.

Doc. No. _____;


Page No. _____;
Book No. ____;
Series of 2017
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF TARLAC ……………………) S.S.

AFFIDAVIT OF LOSS

I, NELSON V. VICTORIA, Filipino, of legal age, single and a resident of Brgy


Bucot, Aliaga, Nueva Ecija after having been duly sworn to in accordance with law do hereby
depose and state:

1. That I am working at the Arm Forces of the Philippines;

2. That as such I was issued an ATM Card with Savings Account by the Land Bank
of the Philippines, Tarlac branch, the ATM No. of which is I could no longer be
remembered;

3. That on January 9, 2018, while I was on a vacation leave, while riding on a public
vehicle the said wallet including the ATM card was lost, now I considered the said
wallet was missing;

4. That I exerted all necessary efforts to locate it, but the same could no longer be
found;

5. That I am executing this affidavit to inform the Land Bank of the Philippines,
Tarlac branch and or proper authorities about the situations for possible
retrieval/replacement of the same and for whatever legal purpose this affidavit
may duly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 10 th day of January 2018
at Tarlac City, Philippines.

NELSON V. VICTORIA
Affiant

SUBSCRIBED AND SWORN to before me this 10 th day of January 2018 at Tarlac


City, Philippines by NELSON V. VICTORIA

Doc. No. _____;


Page No. _____;
Book No. ____;
Series of 2018
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF TARLAC ………… ) S.S.

AFFIDAVIT OF LOSS

I, JUANCHO A. GONZALES, Filipino, of legal age, married and a


resident of Brgy. San Fernando, Victoria, Tarlac, after having been duly
sworn to in accordance with law do hereby depose and state:

1. That I am a holder of ATM Card issued by the Land Bank of the


Philippines;

2. That when I was about to locate said ATM card, I found out it was
missing, and I exerted all necessary efforts to locate it, but the
same could no longer be found;

3. That I am executing this affidavit to inform the Land Bank of the


Philippines, Tarlac branch and or proper authorities about the
situations for possible retrieval/replacement of the same and for
whatever legal purpose this affidavit may duly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of


February, 2018 at Tarlac, Philippines.

JUANCHO A. GONZALES
Affiant

SUBSCRIBED AND SWORN to before me this 9 th day of February,


2018 at Tarlac, Philippines by affiant Juancho A. Gonzales.

Doc. No. _____;


Page No. _____;
Book No. ____;
Series of 2018
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF TARLAC ………… ) S.S.

AFFIDAVIT OF LOSS

I, MARC IAN O’NEAL D. SAN JUAN, Filipino, of legal age, single and
a resident of #267 Sitio Bungil, Sapang Maragul, Tarlac City, after having
been duly sworn to in accordance with law do hereby depose and state:

1. That I am a holder of ATM Card issued by the Union Bank with the
account number 109650479300, at Tarlac Branch;

2. That sometime on March 18, 2018, at around 8:00 in the evening,


after withdrawing at Union Bank, the said ATM card was fell and
lost, now I considered the said ATM was loss;

3. That when I was about to locate said ATM card, I found out it was
missing, and I exerted all necessary efforts to locate it, but the
same could no longer be found;

4. That I am executing this affidavit to inform the Land Bank of the


Philippines, Tarlac branch and or proper authorities about the
situations for possible retrieval/replacement of the same and for
whatever legal purpose this affidavit may duly serve.

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


March, 2018 at Tarlac, Philippines.

MARC IAN D. O’NEAL SAN JUAN


Affiant

SUBSCRIBED AND SWORN to before me this 27th day of March, 2018


at Tarlac, Philippines by affiant Marc Ian O’neal D. San Juan.

Doc. No. _____;


Page No. _____;
Book No. ____;
Series of 2018
REPUBLIC OF THE PHILIPPINES)
PROVINCE OF TARLAC ………… ) S.S.

AFFIDAVIT OF LOSS

I, EMILY C. BASILIO Filipino, of legal age, widow and a resident of


Brgy. Padapada, Sta. Ignacia, Tarlac, after having been duly sworn to in
accordance with law do hereby depose and state:

1. That I am a holder of ATM Card with # 0076117950 issued by the


Land Bank of the Philippines;

2. That on March 16, 2018, when I was about to withdraw, the said
ATM card, was misplaced, and I exerted all necessary efforts to
locate it, but the same could no longer be found;

3. That I am executing this affidavit to inform the Land Bank of the


Philippines, Tarlac branch and or proper authorities about the
situations for possible retrieval/replacement of the same and for
whatever legal purpose this affidavit may duly serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 4 th day of


April, 2018 at Tarlac, Philippines.

EMILY C. BASILIO
Affiant

SUBSCRIBED AND SWORN to before me this 4 th day of April, 2018 at


Tarlac, Philippines by affiant Emily C. Basilio

Doc. No. _____;


Page No. _____;
Book No. ____;
Series of 2018