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Affidavit of Loss - Caritas

Shella Marie C. Deguia executed an affidavit of loss regarding her late husband Salde Salcedo Deguia's life insurance policy agreement with St. Peter Life Plan. She attests that (1) her husband passed away in September 2017 and held a life insurance policy with St. Peter Life Plan, (2) he was issued an agreement for this policy but she cannot locate it despite searching, and (3) she believes the agreement is lost beyond recovery. She signed the affidavit to establish these facts and for its legal purpose.

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Gracelyn Enriquez Bellingan
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2K views1 page

Affidavit of Loss - Caritas

Shella Marie C. Deguia executed an affidavit of loss regarding her late husband Salde Salcedo Deguia's life insurance policy agreement with St. Peter Life Plan. She attests that (1) her husband passed away in September 2017 and held a life insurance policy with St. Peter Life Plan, (2) he was issued an agreement for this policy but she cannot locate it despite searching, and (3) she believes the agreement is lost beyond recovery. She signed the affidavit to establish these facts and for its legal purpose.

Uploaded by

Gracelyn Enriquez Bellingan
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 )

City of Dumaguete ) S.S.


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

AFFIDAVIT OF LOSS

I, SHELLA MARIE C. DEGUIA, of legal age, Filipino, widow, and a


resident of Dumaguete City, Negros Oriental, after having been sworn in
accordance with law, hereby deposes and states the following that:

1. I am the surviving spouse of SALDE SALCEDO DEGUIA who died


last September 6, 2017;

2. My husband is a plan holder of St. Peter Life Plan under Contract No.
N14249359C;

3. He was subsequently issued a St. Peter Life Plan Agreement.


However, when he died, I tried to look for the said agreement. But
the same could no longer be located.

4. Despite diligent search and efforts to locate said agreement, I could


not find the same such that I now believe that it is now lost beyond
recovery;

5. As such, I am executing this affidavit to attest to the veracity of the


foregoing facts and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this


________________ in Dumaguete City, Philippines.

SHELLA MARIE C. DEGUIA


CRN 0111-2039499-6
Affiant

SUBCRIBED AND SWORN TO before me this


__________________in Dumaguete City, Philippines, affiant exhibiting to
me as competent proof of identity the above described ID.

WITNESS MY HAND AND SEAL.

Doc. No. _____;


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

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