Scribd
Upload
206 views3 pages

Affidavit of Loss

1) The affiant pawned an item with a pawnshop and was issued a pawn ticket, but then lost their wallet containing the pawn ticket. 2) Despite searching, the affiant was unable to find the lost wallet and pawn ticket. 3) The affiant is signing this affidavit to attest to losing the pawn ticket from the pawnshop in order to resolve the pawned item.

Uploaded by

Michelle Dulce Mariano Candelaria
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
206 views3 pages

Affidavit of Loss

1) The affiant pawned an item with a pawnshop and was issued a pawn ticket, but then lost their wallet containing the pawn ticket. 2) Despite searching, the affiant was unable to find the lost wallet and pawn ticket. 3) The affiant is signing this affidavit to attest to losing the pawn ticket from the pawnshop in order to resolve the pawned item.

Uploaded by

Michelle Dulce Mariano Candelaria
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
You are on page 1/ 3

(Affidavit of Loss Pawnshop Ticket)

Republic of the Philippines)


Province of ____________________)S.S.
City/Municipality of _____________)
x---------------x
AFFIDAVIT OF LOSS
I, _____________, Filipino, of legal age, (single / married / widow), and a
resident of _____________, Philippines, after being duly sworn in
accordance with law, depose and state:
That sometime on _____________, I pawned my _____________ with
Agencia _____________ located at _____________ and for which I was
issued Pawn Tickets / Receipt No. _____________.

That sometime on _____________, my wallet that contains the said Pawn


Ticket was misplaced and got lost.

That despite diligent search and efforts to locate the said wallet and pawn
ticket, I could not find the same such that I now believe that they are now
lost beyond recovery.

As such, I am executing this Affidavit of Loss to attest to the truth of the


foregoing facts.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________
at _____________, Philippines.
Affiant

(JURAT)
REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI ) S.S.
x----------------------------x

AFFIDAVIT OF LOSS

I, ___________________, of legal age, Filipino, (single/married/widow)


and a resident of _______________________________, after having been
duly sworn to in accordance with law, depose and state THAT:

1. I am a duly-licensed driver in accordance with pertinent Land Transportation


laws, rules and regulations, and was issued a corresponding (Non)
Professional Driver's License with number _____________ which is valid
until _____________;

2. Sometime on ____________, said driver's license was misplaced and got


lost;

3. Efforts were exerted to locate said driver's license, but in spite of diligent
search, it could not be found and the same is now beyond recovery;

4. Said Driver's License has not been confiscated by the LTO, Police or other
Traffic Enforcers for any traffic violation;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the


foregoing and to support my application for the issuance of a new (Non)
Professional Driver's License, in lieu of the one that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand


this ___________________ in Makati City, Metro Manila, Philippines.
____________________

Affiant

SSS ID No. _____________

SUBCRIBED AND SWORN TO before me


this ___________________ in _________________, Philippines, affiant
exhibiting to me his/her competent evidence of identity by way of
__________________ issued at ______________
on __________________.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2013.

You might also like