AFFIDAVIT OF LOSS OF BANK ACCOUNT PASSBOOK
KNOW ALL MEN BY THESE PRESENTS;
I, ROWENA A. ALCANTARA, Filipino, single, of legal age, and a resident of 8231 Kadayawan Drive,
Davao City, after having been duly sworn to in accordance with law, hereby depose and state and declare
that:
1. I am the accountholder of the Banco Filipino – Davao Branch (“Bank”). My deposit account is a
passbook account bearing the following details (‘Account”):
Account Name
ROWENA A. ALCANTARA
Account Number
1234-4321-56
Type
Savings with Passbook
2. My Account’s passbook was last in my possession but lost on or about September 20, 2023, in
Davao City, in the following manner: On the way home from the bank, I accidentally left my
personal documents along with my passbook in the taxicab. I can no longer ascertain the said
passbook’s present whereabouts despite repeated and extensive diligent search made and my
best efforts to locate it proved futile. Said lost passbook is hereby considered null and void and
duly cancelled;
3. I understand and agree that: the Bank’s lost passbook procedure requires account closure and
opening of a new account with issuance of new passbook for the parties’ mutual protection and
good order of bank records; and the Bank, at its sole option without obligation to disclose its
reason(s) to me, may refuse or grant my request. Should the Bank grant my request, this is an
accommodation to me by the Bank.
4. In view of the above, I hereby request the Bank to Close my Account and open a new account with
passbook and issue to me a new passbook.
5. In consideration of the foregoing attestation/declarations, I absolutely, expressly and irrevocably:
a) Acknowledge and confirm receipt from the Bank the remaining funds in my Passbook
Deposit Account No. 1346-0304-56 in the amount of ₱211,000.76 (Philippine Peso) and
that a new passbook in connection with my new Passbook Deposit Account.
I further acknowledge that I absolutely have no right whatsoever to the lost passbook or
the funds indicated in said lost passbook, if for any reason the same is recovered or found
and I agree that the Bank has no obligation to pay me any amount based on the lost
passbook and the remaining balance as appearing in the Bank’s records prevails.
b) Undertake to immediately surrender the said lost passbook in the event that the same
should be found and located ; indemnify and save harmless the Bank, respective directors,
stockholders, officers and employees, successors-in-interest and assigns (“Protected
Parties”) against any claims, suits or causes of action of whatever nature, past, present, or
contingent, as well as any claims for damages, arising out of or in connection, whether
directly or indirectly, with this Affidavit and the Bank’s grant of my above request; and to
pay all costs and expenses (including but not limited to the costs of suit and attorney’s
fees) which may be incurred by the Bank in the enforcement of this Affidavit.
6. Any litigation or suit that may arise in connection with this Affidavit shall only be instituted in
Makati City or in any place where the Bank has a branch/office;
7. This Affidavit may be executed in one or more counterparts, any one of which need not contain
the signature of more than one party, and all of which taken together will for all purposes
constitute one and the same Affidavit, binding on all of the parties, notwithstanding that all of
such parties have not executed the same counterpart. Two or more duplicate originals of this
Affidavit may be signed by the parties, each of which shall be an original but all of which together
shall constitute one and the same Affidavit;
8. Each and all the foregoing facts stated or declared herein are true and correct and that I shall,
when called upon, testify before any court of justice to substantiate the truth and veracity of each
and all of the foregoing facts; and
9. I carefully read this Affidavit and with full understanding of its import and effect I willingly and
voluntarily execute the same.
IN WITNESS WHEREOF, I ROWENA A ALCANTARA, the undersigned has caused these presents to be
executed at Davao City, Philippines, on this 21st day of August, 2024.
ROWENA A. ALCANTARA
Signature above Printed Name
Accountholder
SIGNED IN THE PRESENCE OF:
Signature above Printed Name
Juan C. Crisabakada
Signature above Printed Name
Maria A. Aba-aba
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
City of Davao _______________) s.s.
BEFORE ME, personally appeared:
Name
CTC No.
ROWENA A. ALCANTARA
55661230
Government Issued ID
UMID 0111-2432069
Place of Issue
Davao City
who is personally known to me and to me known to be the same person who executed the foregoing
document and exhibited to me the above Community Tax Certificate; and was identified by me through
competent evidence of identity, to be the same person in the foregoing document who exhibited to me
the above ID. It was acknowledged to me that the execution of this document is the free and voluntary
act and deed of said person, and where applicable, as well as the free and voluntary act and deed of the
entity represented and that said person have the authority to sign in behalf of the entity. The foregoing
document is an AFFIDAVIT OF LOST OF BANK ACCOUNT PASSBOOK which consists of three (3) pages
including the page whereon this Acknowledgment is written. The Acknowledgment forms an integral part
of the said document.
WITNESS MY HAND AND SEAL this 21st day of August, 2024, in Davao City, Philippines.
ATTY. EDGAR ABAKADA
Notary Public
Until December 31, 2024
Commission Serial No. 2024-005820-2025;
Roll No. 34,021
PTR No. 5476988;01-03-24; D.C.
123 ABC Drive, Davao City
Tel. No. 220-1234
Fax No. (082) 220-5678
Doc. No.
Page No.
Book No.
Series of:
086
018
LXVII
2024