AFFIDAVIT OF LOSS OF ATM CARD

REPUBLIC OF THE PHILIPPINES )

CEBU CITY ) SS.

I, _______, Filipino, of legal age, Single, and a resident of Pelaez Extension, Cebu City, after
having been duly sworn in accordance with law, hereby depose and say:

1. That I am a holder of the Metrobank ATM card with account number _________ issued by
Metrobank Ramos, Cebu City;

2. That I used to put said ATM card in my wallet;

3. That in the afternoon of June 11, 2018, before leaving to school, I discovered that my Metrobank
ATM card was no longer in my wallet where I used to place it;

4. That diligent effort to locate the same had proved futile; and to the best of my knowledge, the
same is truly lost;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a
replacement of my Metrobank ATM card.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 13th day of June 2018 at
Cebu City, Philippines.

___________________________

(Affiant)

SUBSCRIBED AND SWORN TO before me, a notary public this 13th day of June 2018. The
affiant, whom I identified through the following competent evidence of identity: (Passport Number
P704645475), valid from May 4, 2018 to May 3, 2028 issued by the Department of Foreign Affairs,
CEbu, personally signed the foregoing instrument before me and avowed under penalty of law to
the whole truth of the contents of said instrument.

Doc. No. ........;

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