Professional Documents
Culture Documents
Affidavit of Loss
Affidavit of Loss
AFFIDAVIT OF LOSS
2. I have recently discovered the said item/s is irretrievably lost and can no longer be found
despite diligent efforts to locate the same;
3. In the event that the lost card should hereafter be found or located, I undertake to forward or
surrender the same FriendlyCare Clinic, Cubao Branch for appropriate disposal.
4. I am executing this affidavit to attest to the truthfulness of the foregoing facts and for what
legal intents and purposes it may serve.
Affiant
Personally came and appeared before me this _22nd_ day of October 2019, at Quezon City,
with Government Issued ID ____________ _, known to me and to me known to be the same
person who executed the foregoing instrument, and acknowledged that the same is his/her free
act and voluntary deed.
WITNESS MY HAND AND SEAL, at the place and on the date first above written.
NOTARY PUBLIC