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Affidavit of Loss: Union Bank ATM Card

Chennette A. Gerian executed an Affidavit of Loss to attest that she lost her Union Bank ATM card with account number 109650766982. She used the ATM machine at Qualfon on January 25, 2018 around 3 AM and believes the card fell out of her blazer pocket on her way home after taking it off. Despite searching, she was unable to find the lost card. She is filing this affidavit to support her application for a new ATM card to replace the lost one.

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Gracelyn Enriquez Bellingan
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2K views2 pages

Affidavit of Loss: Union Bank ATM Card

Chennette A. Gerian executed an Affidavit of Loss to attest that she lost her Union Bank ATM card with account number 109650766982. She used the ATM machine at Qualfon on January 25, 2018 around 3 AM and believes the card fell out of her blazer pocket on her way home after taking it off. Despite searching, she was unable to find the lost card. She is filing this affidavit to support her application for a new ATM card to replace the lost one.

Uploaded by

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

City of Dumaguete ) S.S.


x - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, CHENNETTE A. GERIAN, of legal age, Filipino, single, and a resident


of Poblacion, Plaridel St, Dauin, Negros Oriental, after having been sworn in
accordance with law, hereby deposes and states the following that:

1. That I have an account with Union Bank with Account No.


109650766982and a holder of an ATM Card thereof.

2. That on January 25, 2018, around 3:00 in the morning, after I used the
ATM Machine located at Qualfon, I placed said ATM card in the pocket
of my blazer. However, on the following day, when I tried to search the
said ATM on my blazer, the same is no longer there.

3. That the said ATM might have fall somewhere when I took off my blazer
on my way home.

4. That despite diligent search and efforts to locate the said ATM Card, I
could not find the same such that I now believe that it is now lost
beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the


foregoing and to support the application for the issuance of new one in
lieu of the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this 30th day


of January, 2018 in Dumaguete City, Philippines.

CHENNETTE A. GERIAN
Affiant
TIN 945-161-016-000
SUBCRIBED AND SWORN TO before me this 30th day of January,
2018 in Dumaguete City, Philippines, affiant exhibiting to me her competent
proof of identification.

WITNESS MY HAND AND SEAL.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2018.

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