Affidavit of Loss of Identification Card

_____________________________ ) SS.
I, _____________________________, Filipino, of legal age, single/married to _____________________________, and a resident
of _____________________________, after having been duly sworn in accordance with law, hereby depose and say:
1. That I am a holder of a school/company identification card bearing serial number _____________________________ issued
by _____________________________;
2. (State the circumstances leading to the loss of the ID, e.g.:) That I used to put said identification card in my pouch, among others;
3. That sometime on _____________________________, when I arrived home from work, I discovered that my school/company ID card
was no longer in my pouch where I used to place it;
4. That diligent effort to locate the same had proved futile; (alternative statements:Diligent search of said document proved futile and
unavailing; Despite diligent search and efforts to locate said document, I could not find it, etc.)
5. That said school/company ID card was not confiscated by the authorities of _____________________________ by reason of any
violation of school/company rules and regulations;
6. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a replacement of said school/company
ID card from _____________________________.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of ____________ 20___ at
________________________, Philippines.
(Signature of Affiant over Printed Name)
SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________
20___. The affiant, whom I identified through the following competent evidence of identity: _____________________________, valid
from __________________ to __________________ issued by _____________________________, personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument.
Notary Public
Doc. No. ........;
Page No. .......;
Book No. .......;
Series of 20___.

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