Scribd
Upload
409 views1 page

Affidavit of Loss

1. Marife Omna Ramirez-Penamante filed an affidavit of loss regarding her lost savings passbook from QCRB Bank with account number 11-5804-20 and a balance of 11,216.61 pesos. 2. She lost the passbook in December 2016 when she lost her bag containing the passbook and other documents. 3. Despite efforts to find it, she was unable to locate or recover the lost passbook.

Uploaded by

KhrisAngelPeñamante
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
409 views1 page

Affidavit of Loss

1. Marife Omna Ramirez-Penamante filed an affidavit of loss regarding her lost savings passbook from QCRB Bank with account number 11-5804-20 and a balance of 11,216.61 pesos. 2. She lost the passbook in December 2016 when she lost her bag containing the passbook and other documents. 3. Despite efforts to find it, she was unable to locate or recover the lost passbook.

Uploaded by

KhrisAngelPeñamante
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/ 1

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI ) S.S.


x----------------------------x

AFFIDAVIT OF LOSS

I, MARIFE OMNA RAMIREZ-PENAMANTE, of legal age, Filipino, MARRIED


and a resident of Purok Kamias, Brgy. Ungos, Real, Quezon, after having been
duly sworn to in accordance with law, depose and state THAT:

1. I maintain a Savings Account with S/A No. 11-5804-20 with QCRB Bank with
a credit balance of Eleven Thousand Two Hundred Sixteen pesos and Sixty-
one centavos only (P11,216.61);

2. Sometime on December 2016, the passbook of the above-mentioned account


was lost in the following manner:
I lost my bag which contain the said passbook and other documents.

3. Despite diligent efforts exerted, I could no longer locate, find or recover the
said passbook, and to the best of my knowledge, the same is truly lost;

4. In view thereof, I now desire and hereby request QCRB Bank to issue another
passbook in lieu of the lost one and I am willing to surrender the lost passbook
in the event that the same could be found;

5. As such, I am executing this affidavit to attest to the foregoing facts and to


support the application for the issuance of a new passbook in lieu of the one
which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this February


4, 2017 in Real, Quezon, Philippines.

MARIFE OMNA R. PENAMANTE

Affiant

GSIS 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