x- - - - - - - - - - - - - x AFFIDAVIT OF LOSS I, _____________, of legal age, married, and residing at _______________, Zamboanga City, after having been sworn in accordance with law, hereby depose and say: That I am an employee of the _________________ and as such, I am a member of the Government Service Insurance system; That I have been issued a GSIS e-Card by the GSIS Branch in Zamboanga City, Philippines, thru the Union Bank Zamboanga Branch; That the said e-Card was lost or discovered from my possession; That I have exerted diligent efforts in the search for the said e-Card but all proved futile and that the same is now beyond recovery; That I am executing this affidavit in order to establish the loss of the said e-Card as a fact for all the purposes that this may serve under the law; IN WITNESS WHEREOF, I have hereunto set my hand on this ___ day of _______ in the City of Zamboanga, Philippines. _________________ Affiant SUBSCRIBED AND SWORN to before me on this ___ day of __________ in the City of Zamboanga Philippines. Doc. No.___ Page No.___ Book No.___ Series of 2013