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Sample - Affidavit of Loss

This affidavit of loss was sworn by an individual who states that they are the holder of two documents that have been irretrievably lost despite efforts to locate them. The affidavit identifies the documents as a [document type] issued by [issuer] and a [document type] given by the same issuer. The individual executed this affidavit to attest to the truth of the loss of the documents for legal purposes.

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Paolo Adalem
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136 views1 page

Sample - Affidavit of Loss

This affidavit of loss was sworn by an individual who states that they are the holder of two documents that have been irretrievably lost despite efforts to locate them. The affidavit identifies the documents as a [document type] issued by [issuer] and a [document type] given by the same issuer. The individual executed this affidavit to attest to the truth of the loss of the documents for legal purposes.

Uploaded by

Paolo Adalem
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
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REPUBLIC OF THE PHILIPPINES)

) S.S.

AFFIDAVIT OF LOSS

I, ________________________________, of legal age, Filipino, with residential


address at _____________________________________________, after having been sworn
in accordance with law, do hereby depose and state that:

1. I am a holder of a _____________________ which was duly issued in my


favor by the __________________;

2. I am likewise a holder of a ____________________ which was given to me


by the same ______________;

3. I have recently discovered that the _____________ together with the


_____________ were irretrievably lost and can no longer be found despite
diligent efforts to locate the same; and

4. I am executing this affidavit to attest the truth of the foregoing and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of


___________ 2020 at _____________.

_________________________________
Affiant

SUBSCRIBED AND SWORN, to before me this ___ day of _____________ 2020


at __________________, affiant exhibiting to me her
_________________________________ issued on ____________ at ___________________.

Doc. No. ;
Page No. ;
Book No. ;
Series of 2020.

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