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    Affidavit of Loss - 1

    Uploaded by

    Alfie Sonia Quiero Sanchez

    Copyright:

    © All Rights Reserved

    Affidavit of Loss - 1

    Uploaded by

    Alfie Sonia Quiero Sanchez
    43 views6 pages

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    affidavit of loss - 1

    Copyright

    © © All Rights Reserved

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    Copyright:

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    43 views6 pages

    Affidavit of Loss - 1

    Uploaded by

    Alfie Sonia Quiero Sanchez

    Copyright:

    © All Rights Reserved
    of 6

    Republic of The Philippines )

    Province of Leyte ) S.S.


    Municipality of Carigara )

    AFFIDAVIT OF LOSS

    I, MARIO MARIO, Filipino, married, of legal age, and a resident of Brgy. Barugohay Norte,
    Carigara, Leyte, Philippines, having been duly sworn in accordance with law, hereby depose and
    states:

    1. That I am the holder of the LANDBANK ATM Card with Account Number SA 0187 0646
    78 issued by Landbank Carigara Branch;

    2. That I discovered that the cardholder where I kept my IDs and cards, including the said
    ATM Card, accidentally fell last night when I went out to buy some things at the
    downtown area of Carigara;

    3. That despite diligent search and efforts to locate my ATM Card, I could not find the same
    such that I now believe that it is now lost beyond recovery;

    4. Said ATM Card was not confiscated by any officer of the law or the officer of Landbank
    by reason of any violation of any law, ordinance, presidential decree or rules and
    regulations of said bank; and neither was it offered as collateral for any loan;

    5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request
    for a replacement of my Landbank ATM Card and consequently block the lost one.

    That I am a holder of the


    LANDBANK ATM card with
    account
    number 0957051278 issued by
    Landbank Ormoc Branch;
    2. That sometime last week,
    when I arrived home from
    work I
    discovered that my
    LANDBANK ATM card was no
    longer in my
    wallet where I used to place it;
    3. That despite diligent search
    and efforts to locate my ATM
    Card, I
    could not find the same such
    that I now believe that it is now
    lost beyond recovery;
    4. Said ATM Card was not
    confiscated by any officer of the
    law or
    the officers of LANDBANK by
    reason of any violation of any
    law,
    ordinance, presidential decree
    or rules and regulation of
    said
    bank; and neither was it offered
    as collateral for any loan;
    5. That I am executing this
    affidavit to attest to the truth of
    the
    foregoing facts and to request
    for a replacement of my
    LANDBANK ATM card.
    IN WITNESS WHEREOF, I
    have hereunto affixed my
    signature this __ day
    of June 2017 at Ormoc City,
    Leyte
    That I am a holder of the
    LANDBANK ATM card with
    account
    number 0957051278 issued by
    Landbank Ormoc Branch;
    2. That sometime last week,
    when I arrived home from
    work I
    discovered that my
    LANDBANK ATM card was no
    longer in my
    wallet where I used to place it;
    3. That despite diligent search
    and efforts to locate my ATM
    Card, I
    could not find the same such
    that I now believe that it is now
    lost beyond recovery;
    4. Said ATM Card was not
    confiscated by any officer of the
    law or
    the officers of LANDBANK by
    reason of any violation of any
    law,
    ordinance, presidential decree
    or rules and regulation of
    said
    bank; and neither was it offered
    as collateral for any loan;
    5. That I am executing this
    affidavit to attest to the truth of
    the
    foregoing facts and to request
    for a replacement of my
    LANDBANK ATM card.
    IN WITNESS WHEREOF, I
    have hereunto affixed my
    signature this __ day
    of June 2017 at Ormoc City,
    Leyte
    IN WITNESS WHEREOF, I hereunto affix my signature this 16th day of February, 2021
    at Carigara, Leyte, Philippines.

    MARIO MARIO
    Affiant
    SUBSCRIBED AND SWORN TO BEFORE ME, a Notary Public, this 16th day
    February 2021, affiant personally came and appeared with his TIN ID No. 298-366-347, bearing
    his photograph and signature, known to me as the same person who personally signed the
    foregoing instrument before me and avowed penalty of law to the whole truth of the contents of
    said instrument.

    Doc No. ______


    Page No. _____
    Book No. _____
    Series of 2021.

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