REPUBLIC OF THE PHILIPPINES

City of MANILA  

AFFIDAVIT OF LOSS

I CRISTOPHER T. ADSACA , Filipino, of legal age, married, and with residence

address at Unit 5022 Tower 3 SMDC Light Residences EDSA cor. Madison St., Barangka
Ilaya, Mandaluyong City, after being duly sworn in accordance with law, depose and state:

1. That I am the tenant/owner of Unit 5022 Tower 3 of SMDC Light

Residences EDSA cor. Madison St., Barangka Ilaya, Mandaluyong City;

2. That a few days ago, I discovered the loss of both of my key cards for the
unit;

3. That despite diligent efforts, I could not find nor locate the same and I
believe that it is truly lost;

4. That I am executing this affidavit for whatever legal purposes it may serve
and to request for the replacement of my 2 key cards.

 
As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and
for whatever legal purposes that this may serve.

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

________ 2021 at MANILA, Philippines.

CRISTOPHER T. ADSACA
AFFIANT 

SUBSCRIBED AND SWORN to before me, this __________day of __________ issued at

_______________ on ___________2021.

.Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2021.