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Affidavit of Loss-Motas

Benedicto P. Motas, a resident of Davao del Norte, Philippines, has executed an affidavit of loss for his SSS Identification Card, number 09-0539532-8, which he discovered missing in January 2010. Despite diligent efforts to locate the card, it remains lost. The affidavit is intended to inform the proper authorities and serve any legal purposes necessary.

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Eric Jopson MA
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52 views2 pages

Affidavit of Loss-Motas

Benedicto P. Motas, a resident of Davao del Norte, Philippines, has executed an affidavit of loss for his SSS Identification Card, number 09-0539532-8, which he discovered missing in January 2010. Despite diligent efforts to locate the card, it remains lost. The affidavit is intended to inform the proper authorities and serve any legal purposes necessary.

Uploaded by

Eric Jopson MA
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines .

)
CITY OF TAGUM. . . . . . . ) S.S.
Province of Davao del Norte)
X - - - - - - - - - - - - - - - - - - - - - -X

AFFIDAVIT OF LOSS

I, BENEDICTO P. MOTAS, of legal age, Filipino, married, and a


resident of Purok 3, #054 Betunlan St., Asuncion Poblacion, Davao del
Norte, Philippines, after having been duly sworn to in accordance with law,
hereby depose and say:

1. That I am the same person whose personal circumstances are


stated above;

2. That I am the holder/owner of SSS Identification Card with


bearing number 09-0539532-8, issued by Social Security
System (SSS), Davao City;

3. That sometime in January 2010, I discovered that the said SSS


Identification Card was lost;

4. That despite extra-diligent effort to locate the said SSS


Identification Card, it can no longer be found;

5. That I am executing this affidavit of loss attest to the truth of the


foregoing facts and to inform the proper authority and for
whatever legal purpose/s this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this


___________at Tagum City, Davao del Norte, Philippines.

BENEDICTO P. MOTAS
Affiant
TIN: 901-240-540
Issued by: BIR

SUBSCRIBED AND SWORN to before me this _______________ at


Tagum City, Davao del Norte, Philippines

ATTY. MARIA LINA F. BAURA


Notary Public
Until December 31, 2011
ROLL NO. 46881/PAGE NO. 377; BOOK NO. XIX
PTR NO. 0884606/01-05-10/T.C.
IBP NO. 778871/10-22-09/T.C.
MCLE NO. III-0005250/10-12-09
TIN NO. 178-128-212
Doc No. ____;
Page No. ___;
Book No. ___;
Series 2010.

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