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Affidavit

Wincy Lou Dalumpines, a resident of Antique, Philippines, has executed an Affidavit of Loss stating that their government-issued ID has been lost despite diligent efforts to recover it. The affidavit confirms that the loss was not due to negligence and is intended to support a request for a replacement ID. The document is notarized and includes details for legal purposes.

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Jean Tomugdan
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115 views1 page

Affidavit

Wincy Lou Dalumpines, a resident of Antique, Philippines, has executed an Affidavit of Loss stating that their government-issued ID has been lost despite diligent efforts to recover it. The affidavit confirms that the loss was not due to negligence and is intended to support a request for a replacement ID. The document is notarized and includes details for legal purposes.

Uploaded by

Jean Tomugdan
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 ANTIQUE )
MUNICIPALITY OF SAN JOSE ) S.S.
x-----------------------------------x

AFFIDAVIT OF LOSS

I, WINCY LOU DALUMPINES, of legal age, Filipino, single, and a


resident of Budbudan, Hamtic, Antique, Philippines after having been duly
sworn to in accordance with law, depose and states THAT:

1. That I am a lawful holder of a government issued ID:


________________________;

2. That the lost Identification Card was in my possession and custody,


and I have exercised due care and diligence to keep it safe and
secure;

3. That I have made a diligent search and inquiry to locate the lost
Identification Card but to no avail. It is now irretrievably lost and
cannot be recovered;

4. That the loss of the said Identification Card was not due to any
negligence, willful act, or omission on my part;

5. As such, I am herein executing this Affidavit of Loss to attest to the


truth of the foregoing and to support my request for the
replacement of the said Identification Card and for whatever legal
intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of


______ 2024 in San Jose, Antique, Philippines.

_____________________
WINCY LOU DALUMPINES
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _______


2024, at San Jose, Antique, affiant exhibiting to me his/her ______ ID with no.
________ issued by Republic of the Philippines issued on _______ valid until
________, as his/her competent evidence of identity bearing his/her
photograph and signature.

Doc No. ____; Notary Public


Page No. ___;
Book No. ___;
Series of 2024.

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