REPUBLIC OF THE PHILIPPINES)

) SS.

AFFIDAVIT

I/We, [Registered Owner(s) Complete Name(s)], of legal age, single/married and with postal and
residence address at [Complete Principal Residence Address] under oath depose and state that:

1. I/We obtained a loan from [Name of the Merged/Acquired Bank] secured by a real estate / chattel
mortgage particularly described as follows:

DESCRIPTION / TCT / CCT NO(S). / REGISTRY ENTRY No. / REGISTERED

LOCATION OF CERTIFICATE OF OF DEEDS DATE OF OWNER(S)
PROPERTY(IES) REGISTRATION INSCRIPTION
NO(S) .

2. The aforesaid loan has already been paid in full and was subsequently issued a Release of
Mortgage (ROM) by the above-mentioned Bank, however, a copy of such ROM can no longer be
located even after exhaustive search and diligent efforts.

3. Due to these circumstances, I/We am/are therefore requesting for another copy of a ROM from
BDO Unibank, Inc. (the “Bank”) being the surviving entity.

4. I/We am/are fully aware that the Bank is acting upon my/our request for the release of the
aforesaid mortgage solely upon the faith of this Affidavit as this request is made beyond the
legally mandated retention period for records keeping.

5. I/We hereby absolutely and unconditionally agree to hold free and harmless and to forever
indemnify the Bank, its subsidiaries and affiliates as well as its directors, officers, stockholders,
employees, representatives, successors-in-interest and/or assigns, against any liabilities, claims,
demands, suits, action, loss, damage, charges, expenses or costs (including without limitation of
legal expenses) that may be suffered by the Bank or any third party in relation to the Bank's re-
issuance of the said ROM or the Bank's reliance of any representations made by me/us.

6. I/We am/are this Affidavit to attest the truth of the foregoing narration of facts and for whatever
legal purpose it may serve.

FURTHER AFFIANT(S) SAYETH NAUGHT.

[Name of Affiant(s)]

SUBSCRIBED AND SWORN TO before me at ________________________ on

_____________________, Affiant(s) exhibited to me the following:

Name Valid ID Community Tax Date / Place

Certificate Issued

and is/are personally known to or identified by me to be the same person/s who executed the foregoing
instrument and he/she/they further affirmed and made oath as to the said instrument.

Doc. No. __________;

Page No. __________;
Book No. __________;
Series of __________.