I, age, Filipino, single, and a resident of 625 Sitio Cypa Englis V.

Rama, Cebu City, Cebu, after

having been sworn in accordance with law, hereby deposes and states the following:

1. That I am a holder of the AUB-ATM card with account number 0067-1150-7769

issued by AUB-Mandaue Branch;
2. I have recently discovered the said item is irretrievably lost and can no longer be found
despite diligent efforts to locate the same;

3. I execute the affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.