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Loss, Atm While Driving

The document is an affidavit of loss filed by an individual who lost their automated machine card issued by LANDBANK OF THE PHILIPPINES Tagum City Branch. In the affidavit, the individual states that they discovered their wallet containing the card was lost on November 5, 2019 after it presumably fell from their pocket while driving. They have been unable to locate the lost card despite searching. The individual affirms they have not transferred or sold the card and requests a new card be issued to replace the lost one. They are willing to surrender the lost card if found and sign the affidavit to attest to the truth of the statements.

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Gem Cruz
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64 views1 page

Loss, Atm While Driving

The document is an affidavit of loss filed by an individual who lost their automated machine card issued by LANDBANK OF THE PHILIPPINES Tagum City Branch. In the affidavit, the individual states that they discovered their wallet containing the card was lost on November 5, 2019 after it presumably fell from their pocket while driving. They have been unable to locate the lost card despite searching. The individual affirms they have not transferred or sold the card and requests a new card be issued to replace the lost one. They are willing to surrender the lost card if found and sign the affidavit to attest to the truth of the statements.

Uploaded by

Gem Cruz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines )

Province of _____________)S.S.
Municipality of __________ )
x------------------------------------x

AFFIDAVIT OF LOSS
I, ____________________________ , of legal age, Filipino, and a resident of
__________________________________, Philippines, under oath hereby depose and say that:

1. I am the same and identical person in this affidavit, likewise I am a bonafide depositor
of LANDBANK OF THE PHILIPPINES Tagum City Branch, as such, I was issued an
Automated Machine Card No. _________________________ by the said bank;

2. However, on November 5, 2019, I discovered that my wallet containing the aforesaid


card and other pertinent documents on it which I kept inside my pant’s back pocket
was lost, I presumed that my said wallet fell while I was driving my motorcycle within
this city;

3. The whereabouts of the said card cannot be ascertained despite due and diligent
search;

4. I have never sold, assigned, transferred nor hypothecated said card or any interest
thereof of the funds represented thereby to any person, natural or juridical, in any
manner whatsoever;

5. This affidavit is executed as proof of such loss and request is hereby made for the
issuance of a new card in my favor in lieu of the lost one;

6. I am willing to surrender the lost card in the event that the same could be found or
located;

7. I am executing this affidavit for the aforesaid purpose/s as well as for attesting to the
truth of the statements herein declared, subject to the rules and perjury.

IN WITNESS WHEREOF, I have hereunto set my hand this


_________________________ at ______________________________, Philippines.

___________________
Affiant

SUBSCRIBED AND SWORN to before me this __________________________ at


Asuncion, Davao del Norte, Philippines.

Doc. No. ____;


Page No. ____ ;
Book No. ___ ;
Series of _____.
B

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