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REPUBLIC OF THE PHILIPPINES)

PASIG CITY ) S.S.

AFFIDAVIT OF LOSS

I, LESIEL O. OCINO, of legal age, Filipino, married and a resident of San


Lorenzo Ruiz, Taytay Rizal, after having been sworn in accordance with law,
hereby depose and say that:

1. I am an employee of DIAR’s Assistance Inc. with address at DIAR’s


Bldg., 232 Shaw Boulevard, Mandaluyong City to which a company ID was
issued by my employer when i was hired;

3. On February 07, 2018, I was not able to retrieve my Metrobank ATM


card from the ATM machine of PNB located at the Boni Station of the MRT;

4. Despite efforts to attempt to retrieve my ATM card from the ATM


machine, the said ATM machine was not responding;

5. I execute this Affidavit of Loss in order for me to secure a replacement


for my ATM card;

6. I am executing this affidavit to attest to the truth and veracity of the


foregoing facts and for all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this


___________________ in the city of Pasig.

LESIEL O. OCINO

Affiant

SUBSCRIBED AND SWORN to before me this _________________in


__________________, affiant having exhibited to me her Employee’s ID with
DIAR’s Assistance Inc. with ID No. 1108018763.

Notary Public

Doc No.
Page No.
Book No.
Series of 2018