AFFIDAVIT FOR LOSS ATM CARD

REPUBLIC OF THE PHILIPPINES )S.S

QUEZON CITY )

I, KEVIN YVES DUANE D. ASUNCION, of legal age, married and residing at 35 CEBU STREET,
PAEL ESTATE, BRGY. CULIAT QUEZON CITY after being duly sworn, depose and say;

That I am the holder of an ATM Savings/ Current Account No.8710082064 with BANCO
DE ORO (BDO);
That on or about JULY 3, 2017 my ATM Account No.8710082064 was lost in the following
manner;
I lost time in diligently trying to locate the said document but all efforts exerted
proved futile and to no avail and that the same is considered lost beyond recovery;
That know desire and hereby request BDO to issue a new ATM CARD in lieu of the ATM
lost;
That I am willing to surrender the lost ATM CARD in the event that same could be found and
located;
That I bind myself to hold BDO free and harmless from any loss or damage which may arise
or it may incur in connection with the issuance of new ATM CARD; and
That each and all of the facts herein stated are true and that I am willing to testify before any
court of justice to substantiate the truth of each and all of the above said acts.

IN WITNESS WHEREOF, the undersigned has signed these presents at Quezon City
Philippines, on THIS _____day of__________________2017.

KEVIN YVES DUANE D. ASUNCION

Affiant

SUBSCRIBED AND SWORN to before me in Quezon City Philippines on day of___,2017

Doc No.
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Book No.
Series of 2017