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This document is an Affidavit of Loss, where an individual declares the loss of a specific item despite diligent efforts to locate it. The affiant provides their personal details and the circumstances surrounding the loss, affirming the truth of the statement for legal purposes. The affidavit is to be notarized in Quezon City, Metro Manila.

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Carla Mae Acuña

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0% found this document useful (0 votes)

5 views1 page

Loss Blank

Uploaded by

Carla Mae Acuña

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Available Formats

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REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA) SS.

AFFIDAVIT OF LOSS

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

residence and postal address at
____________________________________________________, after having been duly
sworn to in accordance with law, do hereby depose and states:

1. That I am the holder/possessor of _____________________________________

____________________________________________________________________;

2. That on the said _______

above mentioned was _______________________ despite diligent effort to
search cannot be found considered lost beyond recovery;

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

facts and circumstances and to hereby report to proper authorities
concerned for and mentioned and finally I execute the same for all legal
intents and purposes may served best.

IN WITNESS HEREOF, I hereunto affix my signature this

_________________________, in Quezon City, Metro Manila, Philippines.

________________________________
Affiant

SUBSCRIBED AND SWORN to before me, this _________________________

at Quezon City, Metro Manila, Philippines.

Doc. No. _______; Notary Public

Page No. _______;
Book No. _______;
Series of _______.

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REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA) SS.

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

1. That I am the holder/possessor of _____________________________________

2. That on the said _______

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

IN WITNESS HEREOF, I hereunto affix my signature this

SUBSCRIBED AND SWORN to before me, this _________________________

Doc. No. _______; Notary Public

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REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA) SS.

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

1. That I am the holder/possessor of _____________________________________

2. That on ______________________ the said _____________________________

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

IN WITNESS HEREOF, I hereunto affix my signature this

SUBSCRIBED AND SWORN to before me, this _________________________

Doc. No. _______; Notary Public

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2. That on the said _______