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Affidavit of Loss Sample

The document is an affidavit of loss filed by Roland Mago stating that various identification cards were lost including a Philhealth card, UMID cards, driver's license, voter ID, and ATM cards. Despite searching, the cards could not be found and the affidavit is filed to support an application for replacement cards.

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71 views1 page

Affidavit of Loss Sample

The document is an affidavit of loss filed by Roland Mago stating that various identification cards were lost including a Philhealth card, UMID cards, driver's license, voter ID, and ATM cards. Despite searching, the cards could not be found and the affidavit is filed to support an application for replacement cards.

Uploaded by

prince olan
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

Republic of the Philippines)

[City of Taguig…… ) s.s.

AFFIDAVIT OF LOSS

I, ROLAND MAGO, of legal age, FILIPINO, and a resident of 38 PNP ROAD NORTH SIGNAL TAGUIG,
after having been duly sworn to in accordance with law, do hereby depose and state:
That I am the holder/owner of item below:
PHILHEALTH CARD, UMID CARD, LTO DRIVERS CARD, SSS UMID CARD, COMELEC
VOTERS REGISTRATION , POSTAL ID CARD, BPI & BDO ATM CARD, POLICE
CLERANCE & NBI ID, ORIGINAL COPY OF LTO CERTFICATE OF REGISTRATION &
OFFICIAL RECIEPT OF 2022 MOTORVEHICLE REGISTRATION

That the said PHILHEALTH CARD, UMID CARD, LTO DRIVERS CARD, SSS UMID CARD, COMELEC
VOTERS REGISTRATION, POLICE & NBI CLEARANE ID, POSTAL ID CARD, BPI & BDO ATM CARD,
ORIGINAL COPY OF LTO CERTFICATE OF REGISTRATION & OFFICIAL RECIEPT OF 2022
MOTORVEHICLE REGISTRATION was inadvertently lost and/or misplaced from my possession;

That despite of diligent search and efforts to locate the said PHILHEALTH CARD, UMID CARD, LTO
DRIVERS CARD, SSS UMID CARD, COMELEC VOTERS REGISTRATION , POSTAL ID CARD, BPI & BDO
ATM CARD, POLICE & NBI CLEARANE ID , ORIGINAL COPY OF LTO CERTFICATE OF REGISTRATION
& OFFICIAL RECIEPT OF 2022 MOTORVEHICLE REGISTRATION. I could not find the same such that I now
believe that it is now lost beyond recovery;

That I am executing this affidavit of loss to attest to the truth of the foregoing and to support the application
for the issuance of a new one in lieu of the one which was lost and for whatever legal intent this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this ____ day of _________ in City of Taguig,
Philippines.

Roland Mago
Affiant

SUBSCRIBED AND SWORN before me this ____ day of _________ in City of Taguig Philippines.

Notary Public
Doc. No. ___
Page No. ___
Book No. ___
Series of 2023

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