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Affidavit of Loss

The document is an affidavit of loss filed by Harvey Specter detailing the loss of his driver's license, UMID ID, voter's ID, and wallet containing 20,000 PHP cash. The affidavit states that on May 15, 2021 his convertible car was broken into while parked and the items were missing. The affidavit is sworn before a notary to attest to the truth of the details provided.

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Al Vincent Delgado
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110 views2 pages

Affidavit of Loss

The document is an affidavit of loss filed by Harvey Specter detailing the loss of his driver's license, UMID ID, voter's ID, and wallet containing 20,000 PHP cash. The affidavit states that on May 15, 2021 his convertible car was broken into while parked and the items were missing. The affidavit is sworn before a notary to attest to the truth of the details provided.

Uploaded by

Al Vincent Delgado
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 )

City of Manila…………….) S.S.

AFFIDAVIT OF LOSS

I, Harvey Specter, of legal age, Filipino, seperated, and a resident of #1 King


Towers, Legaspi Village, Makati, after having been sworn in accordance
with law, hereby deposes and states the following THAT:

1. I am holder of a Non-Professional Driver’s License with License


Number N05-21-667884;
2. I am holder of a Unified Multi-purpose ID, (UMID) with ID No.
8796-2347-65312;
3. I am holder of a Voter’s ID with ID No. 0-4912-t486.
4. On May 15, 2021, I left my wallet, containing the three
aforementioned government IDs, inside my vehicle which was parked
in the parking lot of Greenbelt 5;
5. On the same day, on my way to my vehicle, I discovered that the roof
of my car was down, (vehicle is a convertible Mercedes Kompressor
model) and my black wallet which was inside was missing together
with the 20,000php inside the same;
6. The aforesaid items are irretrievably lost and can no longer be found
despite diligent efforts to locate the same;
7. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

________________
Harvey Specter

ACKNOWLEDGMENT

Page 1 of 2
REPUBLIC OF THE PHILIPPINES)
CITY OF MANILA )SS.
X----------------------X
BEFORE ME, a Notary Public for and in the City of Manila,
Philippines, Harvey Specter personally appeared with his TIN identification
card on the 24th of May 2021, known to me and to me known to be the same
person who executed the foregoing instrument and he acknowledged to me
that the same is his own free and voluntary act and deed. This Affidavit of
Loss consists of 2 pages including this page in which this acknowledgment
is written, signed by the affiant each and every page thereof.

ATTICUS FINCH
Notary Public
My Commission Expires Dec.
31, 2021
Doc. No. 3;
3rd Floor San Marcelino
Page No. 40;
Book No. 7; Ermita, Manila
Series of 2021 MCLE Compliance No.
67895234
Issued on -12-30-19
IBP No. 346751367, Sep. 18,
2021, Manila
PTR No.3148967, Sep. 5, 2021,
Manila
TIN 342-643-687-000
ROLL # 92347
Tel No. 82397821

Page 2 of 2

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