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Affidavit of Loss - ATM Card

Affidavit of Loss - ATM Card

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ckayekhb
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59 views1 page

Affidavit of Loss - ATM Card

Affidavit of Loss - ATM Card

Uploaded by

ckayekhb
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)

City of _______________________)S.S.
x-----------------------x

AFFIDAVIT OF LOSS

I, ______________________________ with residence and postal address of


_________________________________________ after having been duly sworn in
accordance with law, hereby depose and say:

1. That I am a depositor of __________________________, with account number


________________________, and such, holder of ______________________

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

3. That quite by misfortune, the said _______________ ATM Card was misplaced and/or
lost. Despite best diligent efforts to locate the same to no avail;

4. That I am executing this affidavit to attest to the truth of the foregoing facts and to request
for a replacement of my Land Bank ATM Card.

IN WITNESS WHEREOF, we have hereunto set our hands this _____ day of ________ at
__________, Philippines.

AFFIANT

ACKNOWLEDGMENT
SUBSCRIBED AND SWORN TO before me, a notary public in and for
_____________________ this ____ day of ____________ 20___. The affiant, whom I
identified through the following competent evidence of identity:
__________________________________________ personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of the contents of
said instrument.

Notary Public

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


Page No. .......;
Book No. .......;
Series of 20…..

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