REPUBLIC OF THE PHILIPPINES)

)S.S.

AFFIDAVIT OF LOSS

I, GEMMA GUARIN ALIDON, of legal age, Filipino and a resident

of Poblacion, San Isidro, Bohol, after having been sworn to in
accordance with law, hereby depose and say that:

1. That I am a bonafide holder of a Metro Classic Card bearing

the numbers 0300061670;

2. That sometime in 2017, I misplaced the said Card;

3. That the said Card could not be found despite diligent efforts
to locate the same;

4. That I am executing this affidavit for the replacement of the

said card, to attest to the truth of the foregoing facts, and for
whatever legal purpose this may serve;

4. Affiant further sayeth naught.

Signed this ___ day of ____________, 2018 at _____________ City,

Philippines.

GEMMA GUARIN ALIDON

Affiant

SUBSCRIBED AND SWORN to before me this __ day of ___________

2018 in ________________, affiant exhibiting to me her Unified Multi-
Purpose ID bearing the numbers CRN-0111-3141805-2 as competent
evidence of her identity.

Doc. No. _____;

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