REPUBLIC OF THE PHILIPPINES)
) S.S.
I, (Name), of legal age, Filipino, married and a resident of (Address), after having been duly sworn to in accordance with law, depose and state:
1. That I am a holder of Automated Teller Machine (ATM) Card No. 0000000000 duly issued in my favor by Bank of Philippine Islands, on (Date) in Quezon City;
2. That I used to put said ATM card in my wallet;
3. That sometime on January 5, 2022, when I arrived home from work, I discovered that said ATM card was no longer in my wallet;
4. That diligent effort to locate the same proved futile;
5. That in view thereof, I now desire and hereby request BDO to issue another ATM card in lieu of the lost one;
6. That I bind myself to save BDO harmless from any loss or damage that it may incur in connection with the issuance of a new ATM card in lieu of the lost one;
7. That I am executing this affidavit to attest to the foregoing facts and for any legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this (Date) in (Place), Philippines.
(Name)Affiant
SUBCRIBED AND SWORN TO before me this (Date) in (Place), Philippines by (Name of Affiant) affiant exhibiting to me his Competent Evidence of Identity by way of Passport Identification (ID Number) issued on (Date) in (Place).
Notary Public
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 20__.