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Affidavit of Loss (Pro Forma)

This affidavit of loss was sworn by an individual who lost an unspecified document issued to them by an unspecified organization. The document was lost, misplaced, destroyed, or stolen sometime on an unspecified date. Despite diligent efforts, the individual was unable to locate the lost document. This affidavit was executed to attest to the truth of the circumstances surrounding the loss of the document and for any legal purposes.

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Chiska Payopanin
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86 views1 page

Affidavit of Loss (Pro Forma)

This affidavit of loss was sworn by an individual who lost an unspecified document issued to them by an unspecified organization. The document was lost, misplaced, destroyed, or stolen sometime on an unspecified date. Despite diligent efforts, the individual was unable to locate the lost document. This affidavit was executed to attest to the truth of the circumstances surrounding the loss of the document and for any legal purposes.

Uploaded by

Chiska Payopanin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Republic of the Philippines )

City of Cebu ) S.S.

AFFIDAVIT OF LOSS

I, ____________________________, Filipino, of legal age,


single/married, and a resident of
___________________________________________after having been duly
sworn to in accordance with law, do hereby deposes and states: That –

1. I am a bona fide owner a __________________________issued to


me by the _________________________________;

2. Sometime on/in _____________________ for unknown reason, the


said ______________________ was lost/misplaced/destroyed/stolen;

3. Diligent efforts were exerted to look for it but the same was futile;

4. I am executing this affidavit to attest the truth of the foregoing facts;


and
5. I am executing this affidavit for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this


_______________________ in Cebu City, Philippines.

  
______________________
Affiant
(Signature over Printed Name)
Competent Proof of Identity
________________________
________________________
Issued on:________________
Issued at:________________

SUBCRIBED AND SWORN TO before me this


____________________ in Cebu City, Philippines. Affiant exhibiting to me
his/her above-mentioned competent evidence of identity bearing his/her
name, picture and signature.

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