REPUBLIC OF THE PHILIPPINES)
______________________________) S.S.
AFFIDAVIT OF LOSS
(______I.D.)
I, __________________, Filipino, of legal age, single, and a resident
________________________________, Philippines, after having been duly sworn in accordance
with law, hereby depose and say:
1. I am a holder of a ____________ I.D. issued by _________________________;
2. About ____________ ago, somewhere _________________________, I lost said
I.D.;
3. I executed diligent efforts to locate the same but proves to be futile and in vain;
4. Hence, the same is deemed lost and at a point beyond recovery;
5. I am executing this affidavit to attest to the foregoing facts and for any legal
purpose it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
_______________ at __________________________.
____________________________________
Affiant
SUBSCRIBED AND SWORN to before me this _______________, in _____________ exhibiting
his/her ______________________________. I certify that I personally examined the affiant and that
she voluntarily executed the foregoing affidavit and understood the contents thereof.
Doc. No.: _____;
Page No.:_____;
Book No.:_____;
Series of 2020