Affidavit of Loss: Republic of The Philippines) ) SS

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REPUBLIC OF THE PHILIPPINES )

) SS.

AFFIDAVIT OF LOSS

I, EMILY APAWAN SANTILLAN, of legal age, Filipino citizen, and a resident of


B6 Lot 3A West Lost Angeles California Vill, San Bartolome, Quezon City, under oath
respectfully state that:

1. That I am the holder and in possession of the:

BPI CREDIT CARD

2. That I lost the same under the following circumstances:

DATE OF LOSS : 2016


PLACE OF LOSS : NOVALICHES
REASON : FELL

2. That I exerted diligent effort to locate it but was in vain for which I now
conclude that the same is now beyond recovery;

3. That I execute this affidavit to attest to the truth of foregoing set of facts and
for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 9th day of


August, 2017.

EMILY APAWAN SANTILLAN


Affiant

SUBSCRIBED AND SWORN to before me this 9th day of August, 2017 at


Valenzuela City by affiant who exhibited to her Drivers License No. N04-02-002582.

Doc. No. 051;


Page No. 011;
Book No. 130;
Series of 2017.

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