Republic of the Philippines)

City of Tagbilaran ) S.S.

AFFIDAVIT OF LOSS

I, HELIODORA B. JUMIGOP, Filipino, of legal age, widow, and with

residence at Poblacion I, Sikatuna, Bohol, Philippines, after being duly sworn to
in accordance with law, do hereby depose and state:

That I am the widower of the late DIOSDADO J. JUMIGOP who died on

September 12, 2018;

That my deceased husband owned a Savings/Checking Account with S/A

No. 612-001-0723119-8 with Armed Forces & Police Savings & Loan Association,
Inc.;

That on or about September of 2018, after the death of my husband, the

Passbook/Certificate of the above-mentioned account, was lost and its
whereabouts cannot be ascertained despite due and diligent search made and
undertaken such that I now believe that the same is lost beyond recovery;

That I now request the Armed Forces & Police Savings & Loan
Association, Inc. to issue a new Passbook/Certificate in lieu of the lost one and I
bind myself to surrender the lost Passbook/Certificate in the event that the same
is found and/or located;

That I covenant to indemnify Armed Forces & Police Savings & Loan
Association, Inc. Bank for any loss and damage it may incur by reason of its
issuance or replacement Passbook/Certificate;

That I am executing this affidavit to attest to the veracity of the above-

stated facts, for the purpose of the issuance of a new Passbook/Certificate or any
other legal purpose which this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 31 st day of

October 2018 at Tagbilaran City, Philippines.

HELIDORA B. JUMIGOP
Affiant
Senior Citizen ID No. 2015-098
OSCA Sikatuna, Bohol

SUBSCRIBED AND SWORN TO BEFORE ME this 31 st day of October,

2018 affiant personally presented to me his Senior Citizen Id No. 2015-098, as
competent and valid proof of his identity.

Doc No. _____;

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