Affidavit of Loss - Umid

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Republic of the Philippines )

Province of Misamis Occidental )


Municipality of Calamba )ss

AFFIDAVIT OF LOSS
Re: UMID CARD

I, X, of legal age, married, Filipino and a resident of Usocan, Plaridel,


Misamis Occidental after having been duly sworn to an oath in accordance with
law, do hereby depose and state:

That I am a government employee under the LGU Plaridel, Misamis


Occidental and a member of GSIS;

That I am a holder of Unified Multi-purpose ID (UMID) with ID No


___________________________;

That the said ID was named X, with address in Barangay Usocan, Plaridel,
Misamis Occidental issued by UNIONBANK (UBP), Pagadian City;

That the said UMID was in my possession however was lost;

That despite diligent efforts exerted to locate it, the same proved futile;

That I am executing this affidavit to prove the veracity and truthfulness of


the foregoing facts for whatever legal purpose it may be worth.

IN WITNESS WHEREOF, I have hereunto set my hand this 27 th day of


May, 2020 in Calamba, Misamis Occidental, Philippines.

X
Affiant

SUBSCRIBED AND SWORN to before me this 27th day of May, 2020 in


Calamba, Misamis Occidental, Philippines, by the affiant who avowed to the
truthfulness of the foregoing affidavit.

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