Affidavit of Loss Umid Id

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REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S. 


                                                     

AFFIDAVIT OF LOSS
 
I, JUAN DELA CRUZ, of legal age, single, Filipino, with residence at Roxas
Street, Bago Bantay, Quezon City, after having been sworn to in accordance with law
hereby depose and say that:

1. I am a holder of a Unified Multi-Purpose (UMID) ID issued by the Social


Security System (SSS) in Ali Mall, Cubao.

2. That on September 1, 2020, while I was doing community service in Batasan


Hills, my wallet was stolen by an unidentified person.

3. My said wallet contains my UMID ID, some valuable Identification cards, and
an amount of money.

4. I took earnest efforts to locate the said wallet and even asked the assistance
of authorities, but to no avail.

5. I execute this affidavit to attest to the truthfulness and veracity of the


foregoing facts, and for the purpose of securing another UMID ID in place of
the stolen one, and for whatever purpose it may serve.

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


September 2020 in Quezon City, Philippines.                 
                   

                                                                    JUAN DELA CRUZ


Affiant                                           
        
 
      SUBSCRIBED AND SWORN to before me this _____ day of September 2020
in Quezon City Philippines. Affiant exhibited to me his competent evidence of
identity as __________________.

Notary Public

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2020.

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