AFFIDAVIT OF LOSS
I, [Your Name], of legal age, Filipino citizen, and resident of [Your Address], Philippines, after
being duly sworn in accordance with law, hereby depose and state under oath:
1. That I am the lawful owner/holder of the following lost item/document: [Specify the lost
item/document, such as identification card, passport, driver's license, etc.].
2. That the lost item/document was in my possession and custody, and I have exercised due care
and diligence to keep it safe and secure.
3. That I have made a diligent search and inquiry to locate the lost item/document but to no avail.
It is irretrievably lost and cannot be recovered.
4. That the loss of the said item/document was not due to any negligence, willful act, or omission
on my part.
5. That I am executing this Affidavit of Loss to attest to the truth of the foregoing facts and for
the purpose of applying for the issuance of a new/replacement item/document.
IN WITNESS WHEREOF, I have hereunto set my hand this [day] of [month], [year], in
[City/Municipality], Philippines.
________________________
[Your Name]
SUBSCRIBED AND SWORN to before me this [day] of [month], [year], in [City/Municipality],
Philippines, affiant exhibiting competent evidence of identity through [type of identification
card] with ID number [ID number], issued on [date of issuance].
WITNESS MY HAND AND SEAL.
Notary Public
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of [Year].
AFFIDAVIT OF LOSS
REPUBLIC OF THE PHILIPPINES)
_____________________________ ) S.S.
I, (Name of Affiant)., Filipino, of legal age, residing at (Address of Affiant), after having been
sworn in accordance with law hereby depose and state:
That I am the true and lawful owner of a certain motor vehicle which is
more particularly described as follows:
MAKE : MOTOR NO. :
SERIES : SERIAL/CHASSIS NO. :
TYPE OF BODY : PLATE NO. :
YEAR MODEL : FILE NO. :
(Remove the table above if the item lost is not a vehicle certificate of registration & change the
declaration below to suit your actual circumstances.)
That sometime in June of this year, I was looking for the original Certificate
of Registration of my car but to my surprise, said Owner’s original Copy could
not found;
That I took pains to look for said Certificate of Registration, but to no avail;
That I am executing this affidavit to attest to the truth of the foregoing and
to request from the Land Transportation Office of Angeles City, a copy of said
Certificate of Registration.
IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________.
20___ at _________________________.
_____________________________
(Name Over Signature of Affiant)
SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___ in
___________________ City, with affiant exhibiting his CTC No. _______________ ,
Issued on ______________________ at _________________________.
NOTARY PUBLIC
Until December 31, 20___
Doc. No. : ________;
Page No. : ________;
Book No. : ________;
Series of 20_______.
AFFIDAVIT OF DESISTANCE
REPUBLIC OF THE PHILIPPINES)
CITY OF MANILA ) S.S.
I, Juan del la Cruz, of legal age, single, and a resident of # 123 Main St., Malate, Manila,
after having duly sworn to in accordance with law hereby depose and state:
1. I am the complaining witness for Serious Physical Injuries against Jesus Santos in the
case entitled "People of the Philippines versus Jesus Santos", Criminal Case No. 12345,
Metropolitan Trial Court, Branch No. 11, City of Manila.
2. After my sober and soul searching assessment and analysis of the incident, I have
realized that because I was not wearing my eyeglasses and it was dark, I can not point out,
without a doubt the accused or any other person/s who inflicted harm against me.
3. Since I could not state with certainty and without doubt the liability of Jesus Santos, in
fairness to him, I am permanently withdrawing my complaint against him. I clear him of
whatever responsibility or liability to me.
4. I hereby inform the City Prosecutor of Manila that I am withdrawing my complaint for
Serious Physical Injuries in Criminal Case No. 12345 entitled "People of the Philippines versus
Jesus Santos", Metropolitan Trial Court, Branch No. 11, City of Manila.
5. I likewise request the Metropolitan Trial Court, Branch No. 11, City of Manila to dismiss
with prejudice the said criminal case.
IN WITNESS WHEREOF, I hereby set my hand this __ day of September 20__ at the City
of Manila.
Juan de la Cruz
Complaining Witness
SUBSCRIBED AND SWORN to before me this 22nd day of January 20__ at the City of Manila,
Philippines.
Romeo Abad
Public Prosecutor
Republic of the Philippines) Province of Bukidnon ) City of Malaybalay ) S.S.
x---------------------------x AFFIDAVIT OF MERIT I, JOHN WAILHIof legal age, married, with residence
and postal address at Purok 4, Kalilangan, Bukidnon, after having been duly sworn in accordance
with the Law, depose and say: That I am a High School Teacher in Kalilangan National High
School. That I have finished my schooling at Xavier- Ateneo De Cagayan University, in the Year
2015 with a degree of Bachelor of Science in Secondary Education, Major in Phusical Science.
That I have enrolled at the Xavier- Ateneo De Cagayan University covering the first semester and
second semester (School Year 2016-2017), and first semester and second semester (School Year
2018-2019),thereby earning 120 units leading to the degree of Masters in Physical Science . That
I have earned a total of 120 units leading to the degree of Masters in
Biological Science. That I am executing this affidavit to attest to the truth of the foregoing facts
andfor the purpose of complying with the requirements of Department Order No. 12, 5-1962,
an enclosure to memorandum No. 51, 5-1962; In witness whereof, I have hereunto set my
hands this 3rd day of March 2021 At Malaybalay City, Province of Bukidnon, Philippines. JOHN
WAILHI AFFIANT SUBSCRIBED AND SWORN TO BEFORE MEthis 3rdday of March 2021 at
Malaybalay City, Province of Bukidnon, Philippines byJOHN WAILHIaboved named affiant and I
herebycertify that I personally examined the affiant and have satisfied myself that she has
voluntarily executed and understood this sworn statement. Doc No. 169;ATTY. ROSH RK B.
CASULLA Page No.34;NOTARY PUBLIC Book No. XXXVI;NOTARIAL COMMISSION NO. 12 Series of
2021UNTIL DECEMBER 2021 ROLL OF ATTORNEYS NO. 6 IBP NO. 5, JANUARY 5, 2019 MCLE
COMPLIANCENO. VI-890
