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Affidavit of Loss: Affiant

This affidavit details the loss of several personal identification cards belonging to an individual. It states that while taking a tricycle, the individual must have dropped their wallet containing an SSS ID, BIR TIN ID, ATM card, and PHILHEALTH ID. Despite earnest efforts, the wallet was not recovered. The affidavit is being filed to declare the items lost in order to request replacements from the proper authorities and for any legal purposes. It is signed and notarized on a specified date in a city in the Philippines.

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veronica villena
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94 views1 page

Affidavit of Loss: Affiant

This affidavit details the loss of several personal identification cards belonging to an individual. It states that while taking a tricycle, the individual must have dropped their wallet containing an SSS ID, BIR TIN ID, ATM card, and PHILHEALTH ID. Despite earnest efforts, the wallet was not recovered. The affidavit is being filed to declare the items lost in order to request replacements from the proper authorities and for any legal purposes. It is signed and notarized on a specified date in a city in the Philippines.

Uploaded by

veronica villena
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

REPUBLIC OF THE PHILIPPINES)

____________________________)S.S.

AFFIDAVIT OF LOSS

I, ______________________, of legal age, Filipino, and a resident of


_____________________________________, after having been duly sworn to in
accordance with law, do hereby depose and say that:

1. I am a holder and in possession of the hereunder enumerated


identification cards/personal belongings, to wit:

a. SSS ID
b. BIR TIN ID
c. ATM CARD
d. PHILHEALTH ID

2. On __________________, while in the vicinity of _____________________, I


boarded a tricycle and while on board, I must have dropped my wallet
containing several personal ID’s including the above-mentioned ID’s;

3. All earnest efforts to locate the said wallet proved futile and of no
avail, hence I am declaring the same to be lost and beyond recovery;

4. That I am executing this affidavit in order to make known to those


concerned the truth relative to the loss of the above-mentioned personal ID’s
and other important paper and documents in compliance with the
requirements of the proper authorities concerned in connection with my
request for the issuance of their replacements after payment of the required
fees and for whatever legal intents and purposes it may serve.

IN TESTIMONY WHEREOF, I have hereunto set my hand this ____ day of


___________________ hereat City of ___________________.

______________________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of


________________ at ________________________.

Doc. No. ____;


Page No. ___;
Book No. ____;
Series of 2019.

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