REPUBLIC OF THE PHILIPPINES )
CITY OF________________) S.S
REPUBLIC OF THE PHILIPPINES)
CITY OF________________) S.S
AFFIDAVIT OF LOST
I____________________________________________, married/single, FILIPINO, of legal
age, and residing at___________________________________________________________________,
After having been sworn in accordance with law hereby deposes and state:
That sometime in _________________________________, I left my License ticket along
Commonwealth Quezon City.
That when I get back to look for it. It nowhere to be found.
That I am executing this affidavit to attest to the truth of the foregoing and to request from your office to
track/locate/ my record.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________________at
____________________.
___________________________________
AFFIANT
SUBSCRIBED AND SWORN to before me this ___________________ in ___________________
With affiant exhibiting his I.D. ____________________________ issued on______________________
at_________________________
No: Name: Contact No: Fb.Account
1.
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Brand New Bike /7 Consolation Prizes: php. 100
No: Name: Contact No: Fb.Account
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No: Name: Contact No: Fb.Account
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REPUBLIC OF THE PHILIPPINES)
CITY OF _________________ ) S.S.
x------------------------------------x
JOINT AFFIDAVIT OF CORRECTION
WE, ___________________ and _________________, both
of legal age, Filipino citizens, married and residents of
_______________________________, after having been duly sworn to in
accordance with law, depose and state THAT:
1. We personally know the person of EARL PADUA ROXAS who was born on April
30, 1994 in Panabo, Davao del Norte, he being the legitimate son of our
close friend and neighbor, the Spouses Rafael Roxas and Cher Padua (both
deceased);
2. In the Certificate of Live Birth of EARL PADUA ROXAS filed in the National
Statistic Office his surname and the surname of his father were erroneously
entered and spelled as “ ROJAS” while his middle name and of his mother were
also erroneously entered as “LADUA”;
3. The true and correct spelling of the middle name and surname of EARL PADUA
ROXAS is “PADUA” and "ROXAS", respectively;
4. The names “EARL PADUA ROXAS” and “EARL LADUA ROJAS" refer to one and
the same person;
5. We are executing this affidavit to attest to the foregoing facts.
IN WITNESS WHEREOF, we have hereunto set our hands
this ___________________ in _______________, Philippines.
__________________
Affiant ____________________
SSS ID No. ___________ Affiant
GSIS ID No. ____________
SUBCRIBED AND SWORN TO before me this ___________________ in
_________________, Philippines, affiants exhibiting to me their valid proofs of
identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.
