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Sample Affidavit of Loss

This affidavit of loss was sworn by [name redacted] to attest that their SSS identification card was lost. The affidavit states that the cardholder used to keep the card in their pouch, but discovered it was missing one day after returning home from work. Despite searching, the card could not be found. The affidavit requests a replacement card and confirms the lost card was not confiscated by any authority. The document was signed and notarized.

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124 views1 page

Sample Affidavit of Loss

This affidavit of loss was sworn by [name redacted] to attest that their SSS identification card was lost. The affidavit states that the cardholder used to keep the card in their pouch, but discovered it was missing one day after returning home from work. Despite searching, the card could not be found. The affidavit requests a replacement card and confirms the lost card was not confiscated by any authority. The document was signed and notarized.

Uploaded by

anneasfsd
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, , Filipino, of legal age, and a resident of # after having been duly
sworn in accordance with law, hereby depose and say:

1. That I am a holder of SSS Identification Card bearing the


name
2. That I used to put said identification card in my pouch.

3. That sometime on when I arrived home from work, I


discovered that my 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 card was not confiscated by any authority or


confiscated by the issuing institution by reason of any
violation of any rules and regulations and law;

6. That I am executing this affidavit to attest to the truth of


the foregoing facts and to request for a replacement of said

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


of

______________________________________
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN TO before me, a Notary Public in and for this The
Affiant, whom I identified through the following competent evidence of identity:
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 2018.

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