Scribd
Upload
20 views1 page

Affidavit of Loss

The document is an affidavit from Imelda Magno Valencia stating that she lost her wallet containing her Social Security System ID card and other identification cards and money while having dinner at a restaurant. She is filing this affidavit to get a replacement SSS ID card and for other purposes.

Uploaded by

hrgenosi
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
20 views1 page

Affidavit of Loss

The document is an affidavit from Imelda Magno Valencia stating that she lost her wallet containing her Social Security System ID card and other identification cards and money while having dinner at a restaurant. She is filing this affidavit to get a replacement SSS ID card and for other purposes.

Uploaded by

hrgenosi
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
You are on page 1/ 1

AFFIDAVIT OF LOSS

I, IMELDA MAGNO VALENCIA, of legal age, married, Filipino, with residence


at 227 Ilang-Ilang Street, St. Christopher 2, Barangay Mayapa, Calamba City, Laguna,
after having been sworn to in accordance with law hereby depose and say that:

1. I am a holder of a Social Security System ID with SS Number 33-3746173-


3 issued by the Social Security System (SSS) in Sta. Rosa, Laguna.

2. In the evening of November 13, 2021, while I was having a dinner in a


restaurant in SM Calamba and when about to pay my bill, I discovered that
my wallet containing my SSS ID and some valuable Identification cards, and
an amount of money was missing.

3. I took earnest efforts to locate the said wallet and even asked the assistance
of authorities, but to no avail.

4. I execute this affidavit to attest to the truthfulness and veracity of the


foregoing facts, and for the purpose of securing another SSS ID in place of the
stolen one, and for whatever purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of


___________________, 2022 in _____________________, Laguna, Philippines.

IMELDA MAGNO VALENCIA


Affiant

SUBSCRIBED AND SWORN to before me this _____ day of ________________,


2022 in ________________________, Laguna, Philippines. Affiant exhibited to me his
competent evidence of identity as ___________________________.

Notary Public

Doc. No____;
Page No. ___;
Book No. ___;
Series of 2022.

You might also like