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Affidavit of Loss - Diploma

The affidavit establishes that the affiant lost her daughter's immunization card and certificate of live birth. She gave birth to her daughter on September 1, 2019 in Talisay District Hospital. The documents were in her possession until she discovered they were lost. The affidavit is to establish the facts of the loss for legal purposes.

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giovanni
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30 views1 page

Affidavit of Loss - Diploma

The affidavit establishes that the affiant lost her daughter's immunization card and certificate of live birth. She gave birth to her daughter on September 1, 2019 in Talisay District Hospital. The documents were in her possession until she discovered they were lost. The affidavit is to establish the facts of the loss for legal purposes.

Uploaded by

giovanni
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CEBU ) S.S.


CITY OF TALISAY )
x- - - - - - - - - - - - - - - - - - - - - - - -/

AFFIDAVIT OF LOSS

I, FIONA MAUREEN VILLANUEVA GEROMO, of legal age, Filipino,


single and a resident of Minglanilla, Cebu City, Philippines, after having been duly sworn
to in accordance with law, do hereby depose and say:

1. That last September 01, 2019, I gave birth to my daughter REIVECKA EVE
GEROMO RAMOS in Talisay District Hospital, San Isidro, City of Talisay,
Cebu, Philippines and was issued a Immunization Card and Certificate of Live
Birth;

2. That the Immunization Card and Certificate of Live Birth of my above


mentioned child was always in my possession until lately I discovered that it
was lost;

3. After the said incident, I could no longer find the said Immunization Card and
Certificate of Live Birth of my baby;

4. That this affidavit is executed to establish the facts of the loss of my


Immunization Card and Certificate of Live Birth and for whatever legal
purpose this may serve;

IN WITNESS WHEREOF, I have hereunto affixed my signature in the City of


Talisay, Cebu this 25th day of September 2019.

FIONA MAUREEN VILLANUEVA GEROMO


Affiant
Police Clearance: OR no. 22883302

SUBSCRIBED AND SWORN TO, before me in this 25th day of September 2019
at the City of Talisay, Cebu. Affiant personally appeared to me.

DOC NO : ___
PAGE NO: ___
BOOK NO: ___
Series of 2019

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