Republic of the Philippines)

LIPA CITY ) S.S

AFFIDAVIT OF LOSS
I, MODESTA A. MARASIGAN, single/married, Filipino, of legal age, and a
resident of Emerald St., Perlas Compound, Kumintang Ilaya, Batangas City, after
having been duly sworn in accordance with law, hereby depose and say:

1. That I am a lawful holder of an ATM Card issued by City Saving’s, Lipa

City with account number _______________________;

2. That I used to put said ATM card inside my wallet;

3. That sometime on December 2014 when I arrived home from work, I

discovered that my ATM Card was no longer in my wallet where I used to place
it;

4. That despite diligent effort to locate the same had proved futile;

5. That I am executing this affidavit to attest to the truth of the foregoing

facts and to request for a replacement of said ATM Card.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 27th day of

January 2015 at Lipa City, Philippines.

MODESTA A. MARASIGAN
PRC ID No. 0129447

SUBSCRIBED AND SWORN before me this 27th day of January 2015 at Lipa
City, Batangas, Philippines. Affiant exhibited to me her Government issued ID
abovementioned as competent evidence of her identity bearing her
photograph and signature in accordance with the 2004 Rules of Notarial
Practice.

Doc. No.___;
Page No.___;
Book No.___;
Series of 2015.
Republic of the Philippines)
LIPA CITY ) S.S

AFFIDAVIT OF LOSS

I, GRACELYN B. AGBAN, married, Filipino, of legal age, and a resident of

Buhaynasapa, San Juan, Batangas, after having been duly sworn in
accordance with law, hereby depose and say:

1. That I am a lawful holder of an ATM Card issued by City Saving’s, Lipa

City, the account number/card number of which I could no longer
remember;

2. That I used to put said ATM card inside my wallet;

3. That sometime on September 2018 when I arrived home from work, I

discovered that my ATM Card was no longer in my wallet where I used
to place it;

4. That despite diligent effort to locate the same had proved futile;

5. That I am executing this affidavit to attest to the truth of the foregoing

facts and to request for a replacement of said ATM Card and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 12th day of

October 2018 at Lipa City, Philippines.

GRACELYN B. AGBAN
Affiant
PRC ID No.1073212

SUBSCRIBED AND SWORN before me this 12th day of October 2018 at Lipa
City, Batangas, Philippines. Affiant exhibited to me her Government issued ID
abovementioned as competent evidence of her identity bearing her
photograph and signature in accordance with the 2004 Rules of Notarial
Practice.

Doc. No. ______;

Page No. ______;
Book No. _______;
Series of 2018.