Affidavit of Loss: Melbie S. Erana

Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 1

AFFIDAVIT OF LOSS

I, MELBIES S. ERANA of legal age, single, Filipino, with residence address at


Block 3 Lot Abada Compond Pingkian 2 Pasong Tamo, Quezon City, after having
sworn in accordance with law, hereby depose and say:

1. That I am the Employee of ______________________________, with principal


place of business at _______________________________________
________________________________________________________________.

2. That I am a holder of the GCASH-ATM Card with account


number_______________________issued by our company;

3. That I used to put said ATM card in my wallet;.

4. That sometimes on November 22, 2016, when I arrived home from ATM
machine BPI, I discovered that my GCASH-ATM was no longer in my wallet
where I used to place it;

5. That diligent effort to locate the same had proved futile;

6. That I execute this affidavit to attest to the truth of the foregoing statements
for a replacement of my GCASH –ATM card.

FURTHER AFFIANT SAYETH NAUGHT.

MELBIE S. ERANA
Affiant

(REPUBLIC OF THE PHILIPPINES) s.s.

SUBSCRIBED AND SWORN to before me this ______day of __________2016,


affiant exhibiting to me his Tax Identification No. ______________ Issued at Quezon
City.

Doc. No. _________


Page No. _________
Book No. _________
Series of 2016

You might also like