AFFIDAVIT OF LOSS OF IDENTIFICATION CARD
REPUBLIC OF THE PHILIPPINES)
_____________________________ ) SS.
I, CHARLIE L. ALA, Filipino, of legal age, and a resident of ZONE 1 LOWER STA ANA SUN VALLEY PARANAQUE CITY,
after having been duly sworn in accordance with law, hereby depose and say:
1. That I am a holder of a government/company identification card bearing serial number UMID 0111-
6334547-8, DRIVERS LICENSE N03-13-024075 and BPI Company ID# 178513 issued by SSS, LTO and BPI;
2. That I used to put said identification card in my wallet inside my bag.
3. That sometime on JUNE 09, 2019, when I arrived home from the store, I discovered that my
government/company ID my whole bag was missing;
4. Despite diligent search and efforts to locate said document, I could not find it.
5. That said government/company ID card was not confiscated by the authorities of government/company
by reason of any violation of government/company rules and regulations;
6. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a
replacement of said government/company ID card from SSS, LTO and BPI.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at
____________, Philippines.
_________________________________
CHARLIE L. ALA
SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____
day of ____________ 20___. The affiant, whom I identified through the following competent evidence of
identity:_____________, valid from______ to______ issued by_______________, personally signed the
foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of
said instrument.
Notary Public
Doc. No. ........;
Page No. .......;
Book No. .......;
Series of 2011.