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Republic of the Philippines)

City of ______) s.s


x------------------ /

AFFIDAVIT OF LOSS

I, ____________, married, Filipino and a resident of ________________________, City, after


having been duly sworn to in accordance with law do hereby depose and say:

1. That I am holder of a valid ________________ ID;

2. That sometime last ____________________________, I noticed that my _______________ID


was missing;

3. That I exerted effort in looking for my ______________________ ID but it proved futile;

4. That I now consider said ____________________________________ ID lost and beyond


recovery;

5. That I am executing this affidavit of loss to attest to the truthfulness and veracity
of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________, 20___ in


______________ City,_____________, Philippines.

_______________________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___________________, 20___ in ___________


City, ____________________, Philippines, affiant showing to me his ________________________ ID,
issued by ____________________, on __________________, 20__.

Doc No:
Page No:
Book No:
Series of 20__

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