REPUBLIC OF THE PHILIPPINES

QUEZON CITY, METRO MANILA

)
) S.S.

AFFIDAVIT OF LOSS
I, FELIPE RODRIGO P. SAN GIL, Filipino, of legal age,
married and a resident of No. 10 Mc Divitt St. Dona

Faustino Vill 1, Culiat Quezon City, after having been

duly sworn to in accordance with law, do hereby depose and
state:
1. That I was issued by the RCBC Bank Greenbelt Branch
Makati with Automated Tellers Machine Card;
2. That the afore-stated
wallet;

ATM Card was contained in my

3. That sometime on January 25, 2013, when I was on the

bus of going to my work in Ortigas, inadvertently my
wallet, without my knowledge, fell-off from my pocket;
4. That unfortunately, however, despite diligent and
exhausted efforts exerted, the same could no longer be
recovered;
5. That for this reason, I am declaring and considering my
aforesaid ATM Card as lost beyond recovery; and
6. I have executed this Affidavit to attest to the truth and
veracity of all the foregoing for all legal intents and
legitimate purpose this may serve.
Affiant Sayeth Naught.
IN WITNESS WHEREOF, I have hereunto set my hand
and affixed my signature on this 12 th day of February, 2012, in
Quezon City.

FELIPE RODRIGO P. SAN GIL

Affiant
SUBSCRIBED AND SWORN to before me this 12 th day of
February, 2012, in Quezon City. Affiant exhibited to me his SSS
ID with no. 33-60365501-3 issued by the Social Security System.

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Page No._____;
Book No._____;
Series of 2013.