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Affidavit of Loss

The document is an Affidavit of Loss from a resident of Tagum City, Philippines, stating the loss of an Acknowledgement Receipt with a principal amount of P45,000. The affiant confirms efforts to locate the receipt were unsuccessful and is executing the affidavit for legal purposes. The document includes spaces for signatures and identification details, as well as notary information.

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Leona School
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28 views1 page

Affidavit of Loss

The document is an Affidavit of Loss from a resident of Tagum City, Philippines, stating the loss of an Acknowledgement Receipt with a principal amount of P45,000. The affiant confirms efforts to locate the receipt were unsuccessful and is executing the affidavit for legal purposes. The document includes spaces for signatures and identification details, as well as notary information.

Uploaded by

Leona School
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 )ss.


x - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS

I, ____________, of legal age, Filipino, (single) and a


resident of ____________________, Philippines, after having
been duly sworn to in accordance with law, hereby depose and
say:

That I am a holder of an ACKNOWLEDGEMENT RECEIPT


bearing No. _________________ with the principal amount of
__________ Pesos only (P45, 000.00) issued to me by the
______________, Tagum Branch, Tagum City, Davao del Norte;

That the said Acknowledgement Receipt was lost and can no


longer be found despite earnest efforts I have exerted to find the
same;

That I am executing this Affidavit to establish the fact of loss


and in connection with the requirement of the ____________
Tagum Branch, Tagum City, Davao del Norte, and for other legal
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this


_____ day of _________ at Tagum City, Davao del Norte,
Philippines.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of


_________ at Tagum City, Davao del Norte, Philippines.Affiant
exhibited to me her (ID no.)_________ as proof of identity.

Doc. No. ______;


Page No. ______;
Book No. _______;
Series of 2022.

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