Republic of the Philippines)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x
AFFIDAVIT OF LOSS
I, MACHIAVELI A. SERAPIO of legal age, Filipino, single, and a resident of
Davao City, after being duly sworn in accordance with law hereby depose and say
that:
1. I am a holder of a Drivers License duly issued by the Land Transportation
Office as well as two ATM Cards duly issued to me by East-West Bank
and China Trust Bank, respectively;
2. The abovementioned Drivers License and ATM Cards were in my
possession from the time of their issue until 21 June 2014 when all were
inadvertently lost in my possession when I lost the bag wherein such were
contained;
3. Notwithstanding diligent efforts exerted to locate them, the same were not
recovered and hence considered lost for all intents and purposes;
4. I attest to the truth of the foregoing circumstances and that I am executing
this affidavit to apprise East West Bank and China Trust Bank of such fact
of loss and for the purpose of being issued a new Drivers License in lieu
of the lost one and for its renewal, if proper, as well as new ATM Cards in
lieu of the lost ones as described above and for whatever other legal
purposes this affidavit may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 24th day
of June 2014, at Davao City, Philippines.

MACHIAVELI A. SERAPIO
Affiant
SUBSCRIBED and sworn to before me, in the City of Davao, this 24th day of
June 2014.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2014.

ATTY. ARNOLD V. DORIA

Notary Public
Until December 31, 2015
PTR No. 3808344 12/18/2013
IBP No. 913048
12/06/2013
Roll No. 57384
MCLE No. IV-0021926
Date Issued: 08/27/2013