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Affidavit of Loss: Voter's ID No.: 1724-0046A-K0676MNA20000 Naga City, Camarines Sur

Ma. Tala N. Acampado files an affidavit of loss regarding the lost passbooks of her deceased common law spouse Pelito B. Obligacion from the PSSLAI and AFPSLAI savings accounts. She attests that she is the mother and guardian of Juan Paolo A. Obligacion, the sole beneficiary and heir of Pelito B. Obligacion. She states that despite diligent search, the passbooks have not been found since going missing around 2001. She requests that new passbooks be issued in the name of Juan Paolo A. Obligacion to access the proceeds of the lost PSSLAI and AFPSLAI passbooks.

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Ann SC
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313 views1 page

Affidavit of Loss: Voter's ID No.: 1724-0046A-K0676MNA20000 Naga City, Camarines Sur

Ma. Tala N. Acampado files an affidavit of loss regarding the lost passbooks of her deceased common law spouse Pelito B. Obligacion from the PSSLAI and AFPSLAI savings accounts. She attests that she is the mother and guardian of Juan Paolo A. Obligacion, the sole beneficiary and heir of Pelito B. Obligacion. She states that despite diligent search, the passbooks have not been found since going missing around 2001. She requests that new passbooks be issued in the name of Juan Paolo A. Obligacion to access the proceeds of the lost PSSLAI and AFPSLAI passbooks.

Uploaded by

Ann SC
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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REPUBLIC OF THE PHILIPPINES )

CITY OF SAN FERNANDO )


PROVINCE OF PAMPANGA ) S.S
x-----------------------------------------x

AFFIDAVIT OF LOSS

I, MA. TALA N. ACAMPADO, Filipino, of legal age, single, and with residence at Zone
6, Sto. Nino, Abella, Naga City , Philippines, after being duly sworn to in accordance with law,
hereby depose and state:

1. That I am the mother and guardian of Juan Paolo A. Obligacion , a minor, who is the
beneficiary of the proceeds of the PSSLAI Passbook and AFPSLAI Passbook of the late
Pelito B. Obligacion , my deceased common law spouse;

2. That Juan Paolo A. Obligacion, is the sole heir of Pelito B. Obligacion. As evidence, I
attached herewith a copy of his Birth Certificate and Affidavit of Paternity to show that Juan
Paolo A. Obligacion is the son of Pelito B. Obligacion.

3. That my common law spouse, PELITO B. OBLIGACION maintain a Savings Account


with PSSLAI and AFPSLAI;

4. That on or about 2001, the Passbook of my late common law spouse, PELITO B.
OBLIGACION, was lost and its whereabouts cannot be ascertained despite due and
diligent search made and undertaken such that I now believe that the same is lost beyond
recovery;

5. That I now request the PSSLAI AND AFPSLAI to issue a new Passbook in lieu of the lost
one in the name of our son Juan Paolo A. Obligacion, the sole beneficiary of the
proceeds of PSSLAI PASSBOOK AND AFPSLAI PASSBOOK;

6. That I am executing this affidavit to attest to the veracity of the above-stated facts, for the
purpose of the issuance of a new Passbook/Certificate or any other legal purpose which
this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at


_____________, Philippines.

MA. TALA N. ACAMPADO


Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this _____ day of _____________,


affiant personally presented to me his Voter’s ID No.: 1724-0046A-K0676MNA20000 issued at Naga
City, Camarines Sur, as competent and valid proof of her identity.

Doc No. _____;


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

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