I, (Emp# ________________) __________________________, of legal age,
Filipino, with residence and postal address at __________________________________ ____________, after having been duly sworn to in accordance with law hereby depose and state that:
1. I am presently employed with <company> <branch> _______________
as ________________________ (position); 2. By virtue of my employment, I was issued an Identification Card; 3. Said Identification Card was lost sometime on ____________________ at ____________________________; 4. Hereunder are the facts and circumstances surrounding the loss of my Identification Card: _________________________________________________________ _________________________________________________________ _________________________________________________________ 5. I made diligent search to recover the said Identification Card but proved futile; 6. For all legal intents and purposes the said Identification Card is now considered lost and beyond recovery; 7. I am executing this affidavit to attest to the truth of the foregoing and for whatever legal purpose/s it may serve.
FURTHER AFFIANT SAYETH NAUGHT.
IN TRUTH THEREOF, I have hereunto set my hand this _____________ day of
___________________20__, at __________________________, Philippines.
__________________ Affiant
SUBSCRIBED AND SWORN to before me this ___________________ day of
______________________ 20__ , affiant exhibited to me his/her Residence Cert. No. __________________ issued at ___________________ on ______________________.
NOTARY PUBLIC
Doc. No. ___________;
Page No. ___________; Book No. ___________; HF-HRD-AOL AMA Group of Companies AFFIDAVIT OF LOSS OF ID CARD Rev: 30 March 2002