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Republic of the Philippines)

City of ____________)S.S.

AFFIDAVIT OF LOSS

I, RAMON SUERTE ESPIA JR., of legal age, with residence and postal
address located at Dolmax Subdivision, Tabuc Suba Jaro, Iloilo, after being
duly sworn according to law, hereby depose and state that:

1. I am the owner of Banco de Oro (BDO) Check Book with Account


No. _____________________ issued by Banco De Oro (BDO) _________________
Branch.

2. I have recently discovered that the said BDO Check Book is


missing, when I needed to issue a check as payment for my telephone bills.

3. Despite diligent efforts exerted, I could no longer locate, find or


recover the said BDO Check Book, and to the best of my knowledge, the
same is truly lost.

4. The said BDO Check Book has not been confiscated by any officer
of the law or the issuing office or agency due to the violation of any law,
statute, order, rule or regulation.

5. In the event that the lost of the BDO Check Book with Account No.
_________________ should hereafter be found or located, I undertake to
forward or surrender the same to BDO ____________ Branch for appropriate
disposal.

6. I am executing this Affidavit to attest to the truth of the foregoing


statements and to request the issuance of a new BDO Check Book in lieu of
the one which was lost.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this


____________________ at _________________________.

______________________
Affiant

SUBSCRIBED AND SWORN to before me this ____________________,


affiant exhibited to me his ID __________________ issued at ______________ on
__________________.

Notary Public
Doc. No. ______
Page No.______
Book No.______
Series of 2018.

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