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Affidavit of Loss of UMID Card

Jon Snow files an affidavit of loss stating that he lost his temporary Government Service Insurance System identification card. He explains that he used to keep the card in his pouch, but discovered it was missing when he returned home from work on August 21, 2016. Despite searching, he was unable to find the lost card. He executes this affidavit to comply with GSIS requirements to reconstitute the lost document.

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Werner Schlager
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17K views2 pages

Affidavit of Loss of UMID Card

Jon Snow files an affidavit of loss stating that he lost his temporary Government Service Insurance System identification card. He explains that he used to keep the card in his pouch, but discovered it was missing when he returned home from work on August 21, 2016. Despite searching, he was unable to find the lost card. He executes this affidavit to comply with GSIS requirements to reconstitute the lost document.

Uploaded by

Werner Schlager
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)

_____________________________) SS.

AFFIDAVIT OF LOSS

I, JON SNOW, Filipino, of legal age, and a resident of Planet of the Apes,
after having been duly sworn in accordance with law, hereby depose and say:

1. That I am a holder of a temporary Unified Multi-Purpose Identification Card


issued by the Government Service Insurance System or GSIS;

2. That I used to put said temporary UMID Card in my pouch;

3. That sometime on August 21, 2016, when I arrived home from work, I
discovered that my temporary UMID card was no longer in my pouch where I
used to place it;

4. Despite diligent search and efforts to locate said document, I could not
find it.

5. That said temporary UMID Card was not confiscated by the authorities of
company by reason of any violation of company rules and regulations;

6. I am executing this affidavit to comply with the requirements of the GSIS


for the reconstitution of said document.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day


of ____________ 20___ at ____________, Philippines.

ROWENA P. VINEGAS

SUBSCRIBED AND SWORN TO before me, a notary public in and for


_____________________ this ____ day of ____________ 20___. The affiant, whom I
identified through the following competent evidence of identity:
_____________, valid from______ to______ issued by_______________, personally
signed the foregoing instrument before me and avowed under penalty of law
to the whole truth of the contents of said instrument.

Notary Public
Doc. No. ........;
Page No. .......;
Book No. .......;
Series of 2011.

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