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Affidavit of Loss: Republic of The Philippines) - , - ) S.S

The document is an affidavit of loss filed by an individual. It states that the individual has lost their identification card or document and cannot find it despite searching. The individual signs the affidavit to attest that the information provided is true. The notary public also signs to verify the identity of the individual filing the affidavit.

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158 views1 page

Affidavit of Loss: Republic of The Philippines) - , - ) S.S

The document is an affidavit of loss filed by an individual. It states that the individual has lost their identification card or document and cannot find it despite searching. The individual signs the affidavit to attest that the information provided is true. The notary public also signs to verify the identity of the individual filing the affidavit.

Uploaded by

Etc Easy
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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Republic of the Philippines )

____________,_____________ ) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:


I, __________________________ of legal age, Filipino, single/married, and a resident of
________________________________________________ , after having been sworn in accordance with
law, hereby deposes and states the following:
1. I am holder/owner/ or possessor of the following identification card / document:
_____________________________

2. I have recently discovered the said item/s is/are irretrievably lost and can no longer be found
despite diligent efforts to locate the same;

3. I execute this affidavit to attest to the truth of the foregoing.


Signed on the date and at the place indicated below.

Affiant
(Signature over Printed Name)
Competent Evidence of Identity
ID # 1: UMID
ID Number: 33-899-41081

ID # 2: PHILHEALTH
ID Number: 01-0503647473

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below. The
affiant exhibited to me his competent evidence of identity as indicated above.

Signed this ______________at ________________, ______________________, Philippines.

WITNESS MY HAND AND SEAL.


Notary Public

Doc. No. __________


Page No. __________
Book No. _________
Series of _________

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