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Affidavit of Loss

This affidavit of loss was sworn by [name] who lost their wallet containing their voter's ID card. They state that on [date] while at [location] they lost their wallet which they usually kept in their back pocket. Despite searching, they were unable to find the lost wallet and ID card. They executed this affidavit to attest to the truth of the loss and to support their application for a new voter's ID to replace the lost one. The affidavit was acknowledged by a notary public.

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506 views2 pages

Affidavit of Loss

This affidavit of loss was sworn by [name] who lost their wallet containing their voter's ID card. They state that on [date] while at [location] they lost their wallet which they usually kept in their back pocket. Despite searching, they were unable to find the lost wallet and ID card. They executed this affidavit to attest to the truth of the loss and to support their application for a new voter's ID to replace the lost one. The affidavit was acknowledged by a notary public.

Uploaded by

Car Dgp
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)

National Capital Region S.S.


City of _____________________
x-----------------------x

AFFIDAVIT OF LOSS

I, _____________, Filipino, of legal age, single, and a resident of


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

1 That on _____________ at around ________, while I was at the


_____________ at _____________, I lost my wallet which I usually place in
my back pocket;

2 That inside the said wallet are my Voter’s ID issued by _____________;

3 That despite diligent search and efforts to locate the said wallet and
my Voter’s ID, I could not find them such that I now believe that they
are now lost beyond recovery;

4 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 a new
Voter’s ID, in lieu of the ones that were lost.

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


at _____________, Philippines.

AFFIANT
REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF ______) SS.
x------------------------------------x

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the City of _____________,


personally appeared _____________ with Identification No. _____________ issued
on _____________ at _____________, whom I have identified through competent
evidence of identity and who represented to me that his signature on the foregoing
instrument was voluntarily affixed by him for the purposes stated in the
instrument and who declared that he has executed the foregoing instrument as
his free and voluntary act and deed.

This Instrument consists of only two (2) pages, including this page in
which this acknowledgment is written, duly signed by _____________.

WITNESS MY HAND AND SEAL this _____________ at _____________,


Philippines.

NOTARY PUBLIC

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