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Affidavit of Loss: Acknowledgment

Karen Reyes Anoling filed an affidavit of loss regarding her lost passbook for her savings account with Rural Bank of San Agustin, Inc. with account number 001-000-6799 and a balance of Php 28,879.30. She attests that she lost the passbook sometime in July 2019 despite searching diligently. She requests that a new passbook be issued and agrees to surrender the lost passbook if found. She also agrees to indemnify the bank for any losses from replacing the passbook.

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Dennis Vidad Dupitas
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22 views2 pages

Affidavit of Loss: Acknowledgment

Karen Reyes Anoling filed an affidavit of loss regarding her lost passbook for her savings account with Rural Bank of San Agustin, Inc. with account number 001-000-6799 and a balance of Php 28,879.30. She attests that she lost the passbook sometime in July 2019 despite searching diligently. She requests that a new passbook be issued and agrees to surrender the lost passbook if found. She also agrees to indemnify the bank for any losses from replacing the passbook.

Uploaded by

Dennis Vidad Dupitas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines)

Province of Isabela) S.S.
City/Municipality of Jones) 
x--------------x

AFFIDAVIT OF LOSS

I, KAREN REYES ANOLING, Filipino, of legal age, married, and with


residence at Barangay 02, Jones, Isabela, Philippines, after being duly sworn to in
accordance with law, hereby depose and state:

That, I maintain a Savings Account with S/A No. 001-000-6799 with Rural
Bank of San Agustin, Inc. with a credit balance of Twenty-Eight Thousand Eight
Hundred Seventy-Nine and 30/100 (Php 28,879.30);

That, on or about sometime on July 2019, the Passbook of the above-


mentioned account, which has always been in my possession, was lost and its
whereabouts cannot be ascertained despite due and diligent search made and
undertaken such that I now believe that the same is lost beyond recovery;
 
That, I now request the Rural Bank of San Agustin, Inc. to issue a new
Passbook in lieu of the lost one and I bind myself to surrender the lost
Passbook/Certificate in the event that the same is found and/or located;

That, I bind myself to indemnify Rural Bank of San Agustin for any loss and
damage it may incur by reason of its issuance or replacement Passbook;

That, each and every fact herein stated is true and I am willing to testify before
any court of justice to substantiate the truth of each and all the said facts.

IN WITNESS WHEREOF, I have hereunto set my hand this 23rd day of


August, 2019 at Jones, Isabela, Philippines.

KAREN R. ANOLING
Affiant

ACKNOWLEDGMENT

Republic of the Philippines)


Province of Isabela) S.S
City/Mun. of _____________) S.S.

BEFORE ME, a Notary Public, for and in _________________, this _______


day of August, 2019, personally appeared Karen R. Anoling, with Resident
Certificate No. 10089374, Issued in Jones, Isabela on January 2, 2019, known to me
to be the same person who executed the foregoing instrument and hereby
acknowledged to me that the same is her free and voluntary act and deed.

Notary Public

Doc. No. ____


Page No. ____
Book No. ____
Series of 2019.

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