Republic of the Philippines)

C I T Y O F D A V A O ) SS.
x- - - - - - - - - - - - - - - - - --x

AFFIDAVIT OF LOSS

I, NILDA LOQUINO VENEZUELA, Filipino, of legal age, married, and a

resident of Davao City, after being duly sworn to in accordance with law do
hereby depose and say that:

1. I am the owner (Customer No. 3185064) of PNBIG SAVINGS

PRIVATE Account No. 3185064400000025 ;

2. However, on or around the third week of September of 2015, I

inadvertently misplaced the passbook associated with the aforestated
account when I was at SM Ecoland;

3. Notwithstanding diligent efforts exerted to find it, the same was not
found, recovered, or located, hence, considered lost and destroyed
for all intents and purposes;

4. I am executing this affidavit without any fraud or intent to deceive on

my part and I forever free any person from any liability that may arise
from this circumstance, and/or any entity, be it governmental or
private;

5. I am therefore executing this affidavit to attest to the truth of all the

foregoing and to apprise any person, natural and juridical,
governmental or private of such fact of loss and for all other legal
purposes this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 1st

day of October 2015, at Davao City, Philippines.

NILDA LOQUINO VENEZUELA

Affiant
SSS No. 09-1965446-6

SUBSCRIBED and SWORN to before me, in the City of Davao, this 1st
day of October 2015, affiant exhibiting to me his/her competent evidence of
identity first written above below his/her name.

ATTY. RALPH JAMES G. LAMAN

Doc No.________ Notary Public
Page No.________ Until December 31, 2015
Book No.________ PTR No. 5259937 12/16/2014
Series of 2015. IBP No. 964441 12/15/2014
Roll No. 62810
MCLE Compliance Exempt1

1
Recently been admitted to the Bar on May 06, 2014.