Professional Documents
Culture Documents
Affidavit of Loss
Affidavit of Loss
Province/City__________________ ) SS.
AFFIDAVIT OF LOSS
I, ________(name)_______, of legal age and residing/with address at ____________________,
under oath, state:
Example:
“1. THAT on 28 February 2005 while riding on a jeepney on my way home, my wallet was pick-
pocketed without my knowledge;”
Example:
“2. THAT my wallet contained my school ID, my Driver’s License and some money bills;”
3. THAT I exerted diligent efforts to locate _____(the thing lost)____ or but to no avail and I
therefore considered the same as lost and can no longer be found;
Example:
“3. THAT I exerted diligence efforts to locate my wallet or identify the culprit but to no avail and
I therefore considered the same as lost and cannot be found;”
4. THAT I am executing this Affidavit to attest to the truth of the foregoing facts and to use the
same for whatever legal purpose it may serve.
__________(name)________
Affiant