Affidavit of Loss sample is provided here to guide in preparing the relevant document in case the ATM is captured by the machine.
Republic of the Philippines)
City of Makati ) S.S.
AFFIDAVIT OF LOSS
I, MAKU LIMUTIN, of legal age, single, Filipino, and a resident of 1234 Quezon Ave., Dinagaan, Legazpi City, after having been duly sworn to, in accordance with law, do hereby depose and state that:
- I was a holder of an Automated Teller Machine (ATM) card of Metrobank with number 13413414151;
- On August 8, 20_____, at about 1:00 o’ clock in the afternoon, I was transacting with ATM machine at PBCom Tower, Makati City when I inadvertently forgot the card in the machine. Upon realizing that I was not able to retrieve the ATM card after my transaction, I returned to retrieve it but did not find the card in the machine.
- I exerted efforts to locate it in every possible place but to no avail and suspected that the next person in line might have gotten it;
- If I ever I will find it in the future I will inform the proper parties/authority about it;
- I am executing this document to attest to the foregoing statements.
MAKU LIMUTIN
Affiant
ID: _______________
SUBSCRIBED AND SWORN to, this _______ day of August 20____, the affiant personally appeared and presented to me her competent evidence of identity shown above.
Doc. No.: __________;
Page No.: __________;
Book No.: __________;
Series of 20____
