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Affidavit of Loss: Republic of The Philippines) Quezon City) S.S X - X

1. The affidavit states that the affiant's wallet containing important IDs was stolen while commuting home on April 8, 2019. 2. The stolen items included the affiant's UMID, PhilHealth ID, TIN ID, and company ID. 3. Despite searching, the affiant was unable to locate or recover the stolen items. The affidavit is being filed to support an application for replacement IDs.

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Lean Paragas
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119 views1 page

Affidavit of Loss: Republic of The Philippines) Quezon City) S.S X - X

1. The affidavit states that the affiant's wallet containing important IDs was stolen while commuting home on April 8, 2019. 2. The stolen items included the affiant's UMID, PhilHealth ID, TIN ID, and company ID. 3. Despite searching, the affiant was unable to locate or recover the stolen items. The affidavit is being filed to support an application for replacement IDs.

Uploaded by

Lean Paragas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)


QUEZON CITY) S.S
x---------------------------------X

I, __________, Jr., Filipino, of legal age, single, and a resident of


________________________________________________, after being duly sworn to in
accordance with law, hereby depose and state:

1. That I am an employee of Environment General Services, Inc. (“EGSI”) at


Shaw Boulevard, Mandaluyong City;

2. That on April 8, 2019, at around 10:00 a.m., while I was commuting on my way
home, my wallet which was in my pants’ pocket was stolen;

3. That inside the said wallet are my a) Unified Multi-Purpose ID (“UMID”) with
No. _____________; b). PhilHealth ID with No. _____________; c) Tax
Identification Number ID (“TIN ID”) with No. _____________; and d) Company
Issued ID;

4. That despite diligent search and efforts to locate and retrieve the said wallet,
my UMID, Philhealth, TIN and Company ID, I could not find them such that I
now believe that they are now lost beyond recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the


foregoing and to support my application for the issuance of IDs.

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


_____________, Philippines.

______________________

Affiant

SUBSCRIBED AND SWORN to before me this ____________________, affiant


exhibited to me his/her Competent Evidence of Identity by way of _________________
issued at ______________ on __________________.

Notary Public

Doc. No.:
Page No.:
Book No.:
Series of:

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