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Affidavit of Loss

The document is an Affidavit of Loss, where the affiant declares ownership of a lost item or document and provides details about the loss. It includes information such as the description of the item, the circumstances of the loss, and the purpose of the affidavit. The affiant also certifies the truth of the statements under penalty of perjury and has it notarized.

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21 views1 page

Affidavit of Loss

The document is an Affidavit of Loss, where the affiant declares ownership of a lost item or document and provides details about the loss. It includes information such as the description of the item, the circumstances of the loss, and the purpose of the affidavit. The affiant also certifies the truth of the statements under penalty of perjury and has it notarized.

Uploaded by

triciagale.jardiel
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/Municipality] …… ) s.s.

AFFIDAVIT OF LOSS
I, [Full Name], of legal age, [Civil Status], [Nationality], and residing
at [Complete Address], after having been duly sworn to in accordance with law,
hereby depose and state that:
1. I am the lawful owner of the following item/document: [Provide a detailed
description of the item/document. For example: “Driver’s License
with License Number 123456789, issued on January 1, 2020, by the
Land Transportation Office (LTO)”].
2. Sometime on or about [date of loss], while I was at [specific location or
circumstance], I discovered that the said item/document was missing.
Despite my diligent efforts to locate or recover it, I have been unable to find
it and now consider it permanently lost.
3. The circumstances surrounding the loss are as follows: [Provide a clear
and concise explanation, e.g., “I was commuting via jeepney along
EDSA when I realized that my wallet containing my driver’s license
was no longer in my bag.”].
4. I am executing this affidavit to attest to the truth of the foregoing facts and
for the purpose of replacing the said item/document or for whatever legal
purpose it may serve.
5. I certify under penalty of perjury that the foregoing statements are true and
correct to the best of my knowledge and belief.
IN WITNESS WHEREOF, I have hereunto set my hand this [date] at [location],
Philippines.

[Signature above printed name]


Affiant
SUBSCRIBED AND SWORN TO before me this [date] at [location], affiant
exhibiting to me his/her [Valid ID and details, e.g., “Philippine Passport No.
P123456789 issued on January 1, 2025”].
[Signature of Notary Public]
[NAME OF NOTARY PUBLIC]
Notary Public

Doc. No. ____


Page No. ____
Book No. ____
Series of 2025.

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