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Burger King

The affidavit details the loss of a GSIS insurance policy by Ray Lloren. Lloren kept important documents securely but was unable to locate policy number 2002319321 set to mature in 2024. Despite efforts, the policy remains lost and irretrievable. The affidavit serves to declare the loss for any legal purposes.

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21 views1 page

Burger King

The affidavit details the loss of a GSIS insurance policy by Ray Lloren. Lloren kept important documents securely but was unable to locate policy number 2002319321 set to mature in 2024. Despite efforts, the policy remains lost and irretrievable. The affidavit serves to declare the loss for any legal purposes.

Uploaded by

irelanditchon
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}

GENERAL SANTOS CITY } S.S.


X---------------------------------------------X

AFFIDAVIT OF LOSS

I, RAY O. LLOREN, of legal age, married to Maribel Edio-Lloren


and a resident of #64 Mentors Village, Malagapas, RH-XI, Cotabato City,
Maguindanao, under oath, hereby depose and state:

1. I am a plan holder of a policy issued by the Government Service


Insurance System (GSIS), bearing Policy No. 2002319321, which is
set to mature on January 30, 2024.

2. I had kept the said policy, along with my other important documents
and files, securely within my residence.

3. Regrettably, due to unforeseen circumstances and inadvertence, I


have been unable to locate the aforementioned policy.

4. Despite diligent and thorough efforts to recover the policy, all


attempts have been unsuccessful, leading me to conclude that it is
now irretrievably lost.

5. I affirm that the lost policy has never been encumbered, pledged,
mortgaged, or utilized as security in any transaction with any
individual or entity.

6. This affidavit is executed to attest to the truth of the above-stated


facts, based on my personal knowledge, and to serve any legal
purposes that may necessitate the declaration of the loss of the
aforementioned GSIS policy.

IN WITNESS WHEREOF, I have hereunto set my hand on this 13th day of


February 2024, General Santos City, Philippines.

RAY O. LLOREN
Affiant

SUBSCRIBED AND SWORN to before me this 13 th day of February


2024, at General Santos City, with his DEPED ID 6414511, issued at
Koronadal City, Philippines.

Doc No. ATTY. IRELAN B. DITCHON


Page No. Notary Public
Book No. PNC 23-249 01-15-24
Series of Roll No.: 65657
BIR 939-960-764
IBP 1331 11-23-23
PTR No. 0971507 11-24-23
MCLE Comp. No. VIII-0000113
2/F Velasquez Bldg., G.S.C.
#09956235608

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