Republic of the Philippines )
Cebu City, Cebu ) 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 ID No. _____________ issued by
__________________________
2. I have recently discovered the said item is 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
_______________________________
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
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