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    Affidavit of Loss Sample

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    mikebasacoy

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    Affidavit of Loss Sample

    Uploaded by

    mikebasacoy
    7 views1 page

    Original Title

    AFFIDAVIT OF LOSS SAMPLE

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    7 views1 page

    Affidavit of Loss Sample

    Uploaded by

    mikebasacoy

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    REPUBLIC OF THE PHILIPPINES)

    TABUK CITY, KALINGA ) S.S.

    AFFIDAVIT OF LOSS

    I, ___________________________, of legal age, Filipino, __________, and


    presently residing _____________________________, after having been duly
    sworn to in accordance with law, hereby depose and say THAT:

    1. I am a HOLDER and OWNER of a Tax Identification Number (TIN)


    card issued by Bureau of Internal Revenue, Tabuk City, Kalinga
    Branch;

    2. I placed the said TIN CARD inside my wallet which I kept inside my
    pocket;

    3. Sometime in _____________________, I lost the said TIN CARD; I


    believe I dropped it somewhere along the road when I am on my
    way home;

    4. I exerted all earnest efforts to locate my TIN CARD but to no avail;

    5. That I am executing this Affidavit to attest to the truth of the


    foregoing facts and to request for the replacement of my TIN CARD
    and for whatever legal purpose and intent it may serve.

    IN WITNESS WHEREOF, I have hereunto affixed my signature this


    ____ day of August, 2024 in Tabuk City, Kalinga, Philippines

    _________________________________
    Affiant
    ID No. ___________
    Issued by_________

    SUBSCRIBED AND SWORN to before me this ____ day of August,


    2024 in Tabuk City, Kalinga, Philippines

    Doc. No. _____;


    Page No. _____; ATTY. YVONNE JADE MANONGYAO-MAYMAYA
    Notary Public for Kalinga
    Book No. IV; Valid Until December 31, 2024
    Series of 2024. Roll No. 80058; May 18, 2022
    PTR No. 3803305; 01-10-2024; Tabuk City
    IBP No. 413781; 01-10-2024
    MCLE No. Admitted to the Bar on May 18, 2022
    Dangwa Street, Purok 4, Bulanao, Tabuk City

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