REPUBLIC OF THE PHILIPPINES)

____________________________) S.S.

AFFIDAVIT OF LOSS
We, SPOUSES DANIEL C. xxxxx and ERLINDA xxxxx-xxxxx, both of
legal age, Filipino Citizens, with residence and postal address at
____________________, after having been sworn to in accordance with law, do
hereby depose and state: THAT
1.

We are joint account owners of two bank accounts, as follows:

Bank
Nature of account
Bank of Philippine Islands (BPI) Joint foreign exchange
Roxas Boulevard, City of Manila
account
Philippine
National
Bank
Joint
Peso
savings
Malilipot, Tabaco, Albay
account

Account number
xxxxxxxx
xxxxxxxx

2.
Unfortunately however, on 20 December 2001 while we were in
transit to New York, Daniel xxxx lost his purse at Kennedy International Airport
containing various documents including the passbooks for the aforestated BPI
foreign currency and PNB peso account passbook.
3.
We have already notified the proper authorities relative to the loss
of our BPI and PNB passbooks.
4.
Despite diligent efforts to locate and retrieve the said BPI and PNB
passbooks, the same could not be found.
5.
This affidavit is executed in order to attest to the veracity of the
foregoing statements and to request the respective banks to issue me a new
passbook as a replacement for the lost one.
AFFIANTS FURTHER SAYETH NAUGHT.
DANIEL C. XXXXXX
Affiant

ERLINDA XXXXXXX
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of May 2002 at

________________; affiants exhibiting to me their respective
Name
Daniel XXXX
Erlinda XXXXX
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2002.

CTC No.
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Date/Place of Issue
5/22/02; Pasay City
5/22/02; Pasay City