Affidavit of Loss: Affiant

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Republic of the Philippines}

Province of Leyte }
Municipality of Palo } s.c.

AFFIDAVIT OF LOSS

I, MARICEL M. OBELLO, Filipino, married, and a resident of Brgy. Cogon, Palo,


Leyte, after being sworn to in accordance with law, hereby depose and say that:

1. I am a registered member of the 4Ps (Pantawid Pamilyang Pilipino Program) and


as such I was issued an ATM Card by the Land Bank of the Philippines;

2. On November 8, 2013, a super typhoon hit the Province of Leyte. Strong winds
devastated our residence and hence I lost such ATM card kept therein;

3. Right after the storm, I exerted all diligent efforts to locate said ATM Card but the
same proved to be futile and I believe that the same is beyond recovery;

4. I am executing this affidavit to attest to the truth of the foregoing and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this FEB 2, 2015 at


Palo, Leyte, Philippines.

MARICEL M. OBELLO
Affiant

SUBSCRIBED AND SWORN to before me this FEB 2, 2015 at Palo, Leyte,


Philippines. Affiant is personally known to the undersigned.

Doc No: 203


Page No: 11
Book No: VI
Series of 2015
Republic of the Philippines}
Province of Leyte }
Municipality of Palo } s.c.

AFFIDAVIT OF LOSS

I, ELIZABETH POTENTE, Filipino, married, and a resident of Brgy. Cogon, Palo,


Leyte, after being sworn to in accordance with law, hereby depose and say that:

1. I am a registered member of the 4Ps (Pantawid Pamilyang Pilipino Program) and


as such I was issued an ATM Card by the Land Bank of the Philippines;

2. On November 8, 2013, a super typhoon hit the Province of Leyte. Strong winds
devastated our residence and hence I lost such ATM card kept therein;

3. Right after the storm, I exerted all diligent efforts to locate said ATM Card but the
same proved to be futile and I believe that the same is beyond recovery;

4. I am executing this affidavit to attest to the truth of the foregoing and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this FEB 2, 2015 at


Palo, Leyte, Philippines.

ELIZABETH POTENTE
Affiant

SUBSCRIBED AND SWORN to before me this FEB 2, 2015 at Palo, Leyte,


Philippines. Affiant is personally known to the undersigned.

Doc No: 204


Page No: 11
Book No: VI
Series of 2015
Republic of the Philippines}
Province of Leyte }
Municipality of Palo } s.c.

AFFIDAVIT OF LOSS

I, BRENDA DY, Filipino, married, and a resident of Brgy. Cogon, Palo, Leyte,
after being sworn to in accordance with law, hereby depose and say that:

1. I am a registered member of the 4Ps (Pantawid Pamilyang Pilipino Program) and


as such I was issued an ATM Card by the Land Bank of the Philippines;

2. On November 8, 2013, a super typhoon hit the Province of Leyte. Strong winds
devastated our residence and hence I lost such ATM card kept therein;

3. Right after the storm, I exerted all diligent efforts to locate said ATM Card but the
same proved to be futile and I believe that the same is beyond recovery;

4. I am executing this affidavit to attest to the truth of the foregoing and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this FEB 2, 2015 at


Palo, Leyte, Philippines.

BRENDA DY
Affiant

SUBSCRIBED AND SWORN to before me this FEB 2, 2015 at Palo, Leyte,


Philippines. Affiant is personally known to the undersigned.

Doc No: 205


Page No: 11
Book No: VI
Series of 2015

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