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Affidavit of Loss (TEMPLATE)

This affidavit of loss details that: 1) The affiant's [document] was lost on a specific date in 201__. 2) Efforts were made but the document could not be found or recovered. 3) The document was not confiscated by any law enforcement or issuing agency for any legal violations. 4) The affiant will surrender the document if later found to the proper authority.

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Shane Borres
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209 views1 page

Affidavit of Loss (TEMPLATE)

This affidavit of loss details that: 1) The affiant's [document] was lost on a specific date in 201__. 2) Efforts were made but the document could not be found or recovered. 3) The document was not confiscated by any law enforcement or issuing agency for any legal violations. 4) The affiant will surrender the document if later found to the proper authority.

Uploaded by

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

) S.S.

AFFIDAVIT OF LOSS

I, ______________________, of legal age, Filipino, after having been duly sworn to in


accordance with law, do hereby depose and state that:

1. Sometime on ___ _________________ 201___, my __________________________ was


lost.

2. Efforts were made to locate the said _____________________ but it could no longer be
found and is already beyond recovery.

3. The said ______________ has not been confiscated by any officer of the law or the issuing
office or agency due to the violation of any law, statute, order, rule, or regulation.

4. In the event that the lost _____________ should hereafter be found or located, I undertake to
forward or surrender the same to the Land Transportation Office for appropriate disposal.

5. I am executing this Affidavit to attest to the truth of the foregoing statements and to request
for the issuance of a new __________________ in lieu of the one which was lost.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ _________________ 201__ at
Parañaque City, Philippines.

____________________
Affiant

SUBSCRIBED AND SWORN TO before me this ____________________, affiant exhibited to


me his Competent Evidence of Identity by way of __________________ issued at ______________ on
__________________.

Doc. No. ______;


Page No. ______;
Book No. ______;
Series of 201___.

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