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Affidavit of Loss - Passbook

Eden D. Juntilla swore in an affidavit that he lost his passbook issued by the Tagum Cooperative on December 4, 2018 despite searching for it. He executed the affidavit to establish the fact of the loss and to request a reissuance of the passbook. The affidavit was sworn before a notary public in Tagum City, Davao del Norte, Philippines on an unspecified date.

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3K views1 page

Affidavit of Loss - Passbook

Eden D. Juntilla swore in an affidavit that he lost his passbook issued by the Tagum Cooperative on December 4, 2018 despite searching for it. He executed the affidavit to establish the fact of the loss and to request a reissuance of the passbook. The affidavit was sworn before a notary public in Tagum City, Davao del Norte, Philippines on an unspecified date.

Uploaded by

Alfie Omega
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines )

Province of Davao del Norte )ss.


x - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, EDEN D. JUNTILLA, of legal age, Filipino, married to Jan


Nieve G. Juntilla, and a resident of Purok 3, La Filipina, Tagum City,
Davao del Norte, Philippines, after having been duly sworn to in
accordance with law, hereby depose and say:

That I am a holder of a Passbook duly issued by the Tagum


Cooperative;

That the said Passbook was lost last December 4, 2018 and
can no longer be located despite earnest efforts I have exerted to
find the same;

That I am executing this Affidavit to establish the fact of loss


and in connection with the requirement for its re-issuance.

IN WITNESS WHEREOF, I have hereunto set forth my


hand this ______________________ at Tagum City, Davao del
Norte, Philippines.

EDEN D. JUNTILLA
Affiant
UMID CARD: CRN-0111-3621446-8

SUBSCRIBED AND SWORN TO BEFORE ME this


___________________ at Tagum City, Davao del Norte,
Philippines. Affiant personally appeared to me exhibiting his
evidence of identity as reflected below his name as competent
proof of his identity.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2018.

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