REPUBLIC OF THE PHILIPPINES )
CITY AND PROVINCE OF ______ ) S.S.
x-------------------------------x
AFFIDAVIT OF LOSS
I, MAMERTO A. INSAG, of legal age, Filipino and a resident of
________________, Philippines, after having been duly sworn to in
accordance with law, do hereby depose and state that:
1. I am the keeper of the original Sales Invoice with number
______, issued in the account of ____________ Inc, ______ City, issued by
_______ Corporation, ___________ City, last April 23, 2019, in the amount
of Eight Thousand Four Hundred Sixty Pesos (P8,460.00);
2. I have usually kept the same document inside my cabinet at
the office including my other important documents;
3. Few months ago, I noticed that the above-mentioned original
Sales Invoice was nowhere to be found;
4. However, I did not really mind it because I still have in my
possession machine copies of the said document;
5. Later, however, I was required by the office to submit the
original copy of the abovementioned Sales Invoice;
6. I tried to look for the same from the usual places where I
would place my other important documents, but despite my efforts of
finding the original Sales Invoices, my search for it and my hopes of
finding the same proved futile;
7. Because of this, I declared the same to be lost and cannot
be found;
8. I am executing this Affidavit in order to attest to the truth of
the foregoing facts and for other legal purpose(s) this may serve best.
IN WITNESS WHEREOF, I have hereunto set my hand this
__________at ________ City, Philippines.
JUAN DELA CRUZ
Affiant
The affiant whose name and personal circumstances are stated
above, personally appeared before me this __________ in the City of
Iloilo, Philippines, presented the foregoing affidavit, signed the same in
my presence and affirmed under oath to the correctness of the
contents or allegations of the same.
The affiant was identified by competent evidence of identity,
namely a UMID CRN – XXXXXXX bearing her photograph and
signature.
Doc. No. ;
Page No. ;
Book No. ;
Series of 2018.
