REPUBLIC OF THE PHILIPPINES )
KALINGA PROVINCE ) S.S.
AFFIDAVIT OF LOSS
I, __________________ of legal age, Filipino, with address at
______________________________________, after having been duly sworn to in
accordance with law, depose and state THAT:
1. I am a Holder of the ___________________________ bearing Id No.
_____________________________;
2. On ___________________, was the wedding day of my cousin and
our other relatives slept over in my room and the day after the
wedding I discovered that my ___________________ was longer in
my room which I usually put on the table inside my room;
3. I tried to look for it but I did not find the same and I asked my
family members and relatives if they have seen my
____________________ but all answered in negative;
4. Efforts were exerted to locate my ____________________, but spite
of diligent search, it could not be found and the same is now
beyond recovery;
5. As such, I am executing this Affidavit of Loss to attest to the
truth and veracity of the foregoing and to support my application
for the issuance of a new __________________ in lieu of the one
that was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day of
November 2024 in __________________________.
____________________________
Affiant
SUBCRIBED AND SWORN TO before me this 12th day of November
2024 in _______________________, Philippines, affiant exhibiting to me his
______________________ with ID No. __________________________ as proof of
his identity.
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2024.
