8/19/2019 Affidavit of Loss Patiluna
1/1
REPUBLIC OF THE PHILIPPINES)
CITY OF CEBU ) S.S.
x--------------------------------/.
AFFIDAVIT OF LOSS
I, VAN BORCES PATILUNA, of legal age, Filipino,
a!!ie" an" a !e#i"en$ of T%la&
U!'an Hoe#, C%'a(%', an"a%e Ci$&, af$e! *a+ing 'een "%l&
#o!n $o in a((o!"an(e i$* la,
"epo#e an" #$a$e THAT :
. La#$ Fe'!%a!& , 01, I lef$ & Copan& I.2 'ea!ing
no. 01123 a$ $*e
p*o$o(opie! of USC-TC *ile I *a" i$ p*o$o(opie" a#
!e4%i!een$# fo! $*e appli(a$ion of loan5
. I$ a# onl& *en I a!!i+e" *oe $*a$ "a& *en I no$i(e"
$*a$ & Copan& I.2 a# no$
in & po(6e$5
. I in4%i!e" $o $*e in-(*a!ge of $*e p*o$o(opie! if *e no$i(e"
& Copan& I.2 '%$ *e
!e#pon"e" in $*e nega$i+e.
7. Effo!$# e!e exe!$e" $o lo(a$e $*e #ae, '%$ in #pi$e of
"iligen$ #ea!(*, i$ (o%l" no$ 'e
fo%n" (!ea$ing a 'elief $*a$ I p!o'a'l& ina"+e!$en$l&
lo#$ i$ #oe*e!e *i(* i# no 'e&on"
!e(o+e!&5
8. 9# #%(*, I a exe(%$ing $*i# 9ffi"a+i$ of Lo## $o a$$e#$ $o
$*e $!%$* of $*e fo!egoing an"
fo! $*e p%!po#e of i##%an(e of a ne Copan& I.2.
IN WITNESS WHEREOF, I *a+e *e!e%n$o #e$ & *an" $*i# 8
$* "a& of a!(* 01, in
Ce'% Ci$&, P*ilippine#.
VAN BORCES PATILUNA
9ffian$
SUBCRIBED AND SWORN TO 'efo!e e $*i# 8$* "a& of
a!(* in Ce'%
Ci$&, P*ilippine#, affian$ ex*i'i$ing $o e *i# (ope$en$
e+i"en(e of i"en$i$& '& a& of a
2!i+e!:# Li(en#e No. ;0-33-737
