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REPUBLIC OF THE PHILIPPINES)

TARLAC CITY )S.S.

AFFIDAVIT
I, VIOLINA D. SABEROLA, of legal age, and a resident of 286 Blk 3, Don
Panlilio, Balibago 1st, Tarlac City, after having been duly sworn to in accordance
with law, do hereby depose and say, to wit:

1. That I am a holder of a Passbook with an Account No. 88031225-21


issued by Bank of the Philippine Islands (BPI) Tarlac Branch;

2. That sometime on November 11, 2018 at about 4:00 in the morning,


my vehicle was properly parked at Tarlac Public Market, when I
returned, I’ve noticed that I lost my bag which I placed inside my
vehicle;

3. That inside the above-said bag is my BPI Passbook;

4. That recently, despite diligent efforts exerted to locate the same, it


could no longer be found and is now deemed lost and beyond
recovery;

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


foregoing statements and facts.

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 13th day of


November 2018 at Tarlac City, Philippines.

VIOLINA D. SABEROLA
Affiant

SUBSCRIBED AND SWORN to before me this 13th day of November 2018 at


Tarlac City, Philippines.

Doc. No. _____;


Page No._____;
Book No._____;
Series of 2018.