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Republic of the Philippines ) S.S.

City of Surigao )

AFFIDAVIT OF LOSS

I, JOIE DANIELLE L. GARCIA, of legal age, single, Filipino


citizen and a resident of 03889 Narciso Street, Surigao City,
Surigao del Norte, after being duly sworn on oath accordance
with law, hereby depose and say:

That I am a holder of a Landbank of the Philippines (LBP)


ATM Card with Acct/Card No.____________________ issued by
Landbank of the Philippines (LBP), Surigao Branch;

That sometime in March 2018, while I was searching for


my wallet, I discovered that it was missing inside my bag where I
usually put the same;

That I tried to retrace the places where I have gone and


even went to extent of inquiring from my friends and other
persons in order to locate my wallet. All efforts were exerted to
locate and retrieve my wallet which contained my LBP ATM Card,
but to no avail. In view thereof, the same is hereby considered
for all intents and purposes, as permanently lost.

That I am executing this Affidavit to attest to the truth and


veracity of all the above statements and to prove the
circumstances surrounding the loss of my LBP ATM Card and for
whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on


this ____day of April, 2018 in Surigao City, Philippines.

JOIE DANIELLE L. GARCIA


Affiant

SUBSCRIBED AND SWORN to before me on this ____ day


of April, 2018 in Surigao City, Philippines, the affiant exhibiting
to me her CTC No.______________ issued on ___________ at Surigo
City, as competent proof of her identity.

DOC. NO. _____;

PAGE NO. _____;

BOOK NO. _____;

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