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    Loss Policy

    Uploaded by

    Cristine Donaire-Sipalay

    Copyright:

    © All Rights Reserved
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    Loss Policy

    Uploaded by

    Cristine Donaire-Sipalay
    1 views1 page

    Original Title

    loss policy

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    Loss Policy

    Uploaded by

    Cristine Donaire-Sipalay

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    REPUBLIC OF THE PHILIPPINES }

    CITY OF DIGOS, DAVAO DEL SUR}

    AFFIDAVIT OF LOSS
    I, ROLANDO T. PANTIL, Filipino, of legal age, widower and a
    resident Luna Ext., San Miguel, Digos City, Davao del Sur, Philippines,
    after having been duly sworn to in accordance with law, do hereby
    depose and say that:

    1. I am the same and identical person who was a member of


    Government Service Insurance System (GSIS)-Davao City Branch for
    which she was issued a policy or certificate with number
    _______________________ evidencing her membership;

    2. Unfortunately, the said policy or certificate the said copy was


    nowhere to be found among her files, diligent efforts to locate the
    same in places where it should normally be located, proved futile and
    unyielding;

    3. Hence, I am declaring the same to be lost and irretrievably so.

    4. I am, therefore executing this affidavit to apprise the


    Government Service Insurance System (GSIS)-Davao City Branch of the
    fact of the loss of the said certificate.

    FURTHER AFFIANT SAYETH NAUGHT.

    IN WITNESS WHEREOF, I have hereunto set my hand 11th day of


    March 2024 in Digos City, Davao del Sur, Philippines.

    ROLANDO T. PANTIL
    ________________________________
    AFFIANT

    SUBSCRIBED AND SWORN to before me this 11th day of March


    2024 in Digos City, Davao del Sur, Philippines, affiant having exhibited
    to me his competent evidence of identity OSCA 312321 as the same
    person who signed this instrument.

    Doc. No. :447;


    Page No. : 89;
    Book No. : LVIII;
    Series of 2024.

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