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Republic of the Philippines }
City of Bacolod } S.c.
x------------------------------------x AFFIDAVIT OF LOSS I, JOSEFINA S. YAP, of legal age, married, ilipino and a resident of !"#$ %a&aan Road 'illa (ngela Subd., 'illamonte, Bacolod City, Philippines, after ha)ing been duly s&orn in accordance &ith la&, do hereby depose and say that* I am the depositor of a +ollar Sa)ings (ccount passboo, &ith account no. !$-."$$/0/$- in B+1 2ast Branch. 3hen I &as about to deposit sometime in the first &ee, of 4ay /$!", I noticed that my passboo, is missing. I immediately notified the ban, of my loss. +espite my diligent efforts to locate the abo)e-mentioned passboo, for the last couple of days no&, I am unable to locate the same. I execute this affida)it for the purpose of attesting to the truth of the foregoing facts and for &hate)er legal purpose it may ser)e best. I further sayeth none. JOSEFINA S. YAP Affiant S5BSCRIB2+ (6+ S31R6 71 B21R2 42 this 8888 day of 4ay, /$!" at the City of Bacolod, the affiant exhibiting to me her Community 7ax Certificate 6o. 9 :o)ernment Issued I+ 8888888888888888888 issued at 8888888888888888 on 8888888888888888. +oc. 6o. 88888 Page 6o. 8888 Boo, 6o.88888 Series of /$!".