Nelson S. Morillo lost his ATM card issued by Land Bank of the Philippines Catarman Branch on July 03, 2023. He is filing this affidavit to attest that he lost the card and is unable to find it, that the money in the account is his personal property, and that the card was not confiscated or used as collateral. He is requesting a replacement ATM card and agrees to hold LBP harmless for any losses from issuing a new card.

1. 1 | P a g e A F F I D A V I T O F L O S S
REPUBLIC OF THE PHILIPPINES)
MUNICIPALITY OF __________ ) S.S.
AFFIDAVIT OF LOSS-ATM CARD
I, NELSON S. MORILLO, of legal age, Filipino, single, with residential address
at Brgy. Dale, San Roque, Northern Samar after having been duly sworn to in
accordance with law, do hereby depose and say that:
1. I am a holder of Automated Teller Machine (ATM) card with number
________________ under Account No. 11970027-31 issued to me by Land
Bank of the Philippines (LBP) Catarman Branch, Catarman, Northern Samar;
2. The credit balance of this account is P________as of ___________.
2. I lost said ATM on July 03, 2023, and that I exerted all efforts to locate the
same but could not remember exactly where I place/left it and it is considered
lot for all legal purpose;
3. The money represented by the balance to the credit of the account is my
personal property and that I have no assignment, transfer or pledge thereof;
3. Said ATM card was not confiscated by any officer of the law or officers of DBP
by reasons of any violation of law, ordinance or rules and regulations of the
bank, and NEITHER WAS IT OFFERED AS COLLATERAL FOR ANY LOAN;
4. I am executing this affidavit to attest to the foregoing facts and for the
purpose of securing the issuance to me of a replacement ATM card in lieu of
the one that was lost;
5. I hereby agree to hold the Land Bank of the Philippines, its officers, and
employees, from any liability and to indemnify them for any lost they may
sustain by issuing another ATM Card.
AFFIANT FURTHER SAYETH NOT.
IN TRUTH WHEREOF, I have hereunto set our hands this _____th day of
____________ 2023 at __________, Northern Samar, Philippines.
NELSON S. MORILLO
Affiant
Proof of Identity: Prov. ID No. 937
SUBSCRIBED AND SWORN to before me, this ______affiant exhibited to
me competent evidence of identity as indicated above.
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 2023