Republic of the Philippines)

___________,__________ )

AFFIDAVIT OF LOSS

I, Bilbo Baggins, of legal age, Filipino, married, and a resident of Unit 5A,
Bag End Street, Paco, Manila, after gaving having been sworn in accordance
with law, hereby deposes and states that:

1. That I am a verified holder of a Rizal Commercial Banking

Corporation(RCBC) Automated Teller Machine(ATM) card with an account
number of 0987654321;
2. That on the evening of June 7, 2019, while I was walking home, I realized
that the said ATM card was missing in my wallet.
3. That I have exerted diligent and extra effort to retrieve the aforesaid
item but my effort prove to be futile and to no avail;
4. That I have executed this affidavit to attest to the truthfulness of the
foregoing statements.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day

of _____ , 2019 in _______________, Philippines.

________________
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of _____ 2019 in
_____________, Philippines, affiant exhibiting to me his competent proof
of identity.