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    Affidavit of Loss (Sample)

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    Affidavit

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    Affidavit of Loss (Sample)

    Uploaded by

    dlos files
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    Affidavit

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    © © All Rights Reserved

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    Affidavit

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3 views1 page

    Affidavit of Loss (Sample)

    Uploaded by

    dlos files
    Affidavit

    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 )

    City of Pasig City ) S.S.


    x------------------------x

    AFFIDAVIT OF LOSS

    I, _____(Name)__________, of legal age, Filipino, widow, and a resident of


    _______________(Address)________________ after having been duly sworn in accordance
    with law, hereby depose and say that:

    1. I am a duly legal holder of the following Identification Cards and ATM to wit;

    a. SSS ID

    b. TIN ID

    c. Phil health ID

    d. Landbank ATM Cards (2pc)

    e. Passbook Landbank

    f. Union Bank ATM Card

    2. On or about 6:30 am contained in my wallet was misplaced and got lost;

    3. Efforts were exerted to locate said driver's license, but in spite of diligent search, it
    could not be found and the same is now beyond recovery;

    4. I am executing this Affidavit of Loss to attest to the truth of the foregoing and to
    support my application for the issuance of a new ATM Cards other pertinent IDs, in lieu of the
    one that was lost;

    Affiant states nothing further.

    IN WITNESS WHEREOF, I have hereunto affixed my signature this ______ day of _____
    __________ in Pasig City, Philippines.

    _____________________
    Affiant

    SUBSCRIBED AND SWORN TO before me this ______ day of ________ 2023 in Pasig City,
    Philippines, affiant exhibited her _____________ Identification Card as herein above indicated.

    Doc. No._____;
    Page No._____;
    Book No._____;
    Series of 2023.

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