I, Joselito V. Bustillo, Filipino, of legal age, residing at 125 Villanueva Street, Dalandanan,
Valenzuela City, after having been sworn to in accordance with law hereby depose and state:
That I am the holder of the Security Bank ATM card with account no 0111 334 903 310;
That around 5:30 p.m. of March 24, 2015, during rush hour in Light Rail Transit 1 (LRT1), my
wallet was picked pocket from my bag containing the aforementioned ATM Card;
That I am executing this affidavit to attest to the truth of the foregoing facts for the purpose of
replacement of the said ATM Card.
IN WITNESS WHEREOF, I have hereunto set my hand on this _______day of March 2015 in
the City of Manila.
JOSELITO V. BUSTILLO
Affiant
SUBSCRIBED AND SWORN to before me in the City of Manila this _____ day of March 2015
by the affiant, who has satisfactory proven to me through his SSS No. 33-1482-005-4 issued at
____SSS , that he is the same person who personally signed this affidavit before me and
acknowledged that he executed the same.