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    Pro Forma Affidavit of Loss

    Uploaded by

    Erin Gamer
    This affidavit details the loss of important documents and items by an individual. It states that the affiant lost their ID card, ATM card, or other documents on a specific date and time due to being unintentionally misplaced, accidentally dropped, stolen, burned, or otherwise damaged and are now considered completely lost. The affiant is swearing to the truth of this statement to secure replacements for the lost items.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Pro Forma Affidavit of Loss

    Uploaded by

    Erin Gamer
    311 views1 page
    This affidavit details the loss of important documents and items by an individual. It states that the affiant lost their ID card, ATM card, or other documents on a specific date and time due to being unintentionally misplaced, accidentally dropped, stolen, burned, or otherwise damaged and are now considered completely lost. The affiant is swearing to the truth of this statement to secure replacements for the lost items.

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    This affidavit details the loss of important documents and items by an individual. It states that the affiant lost their ID card, ATM card, or other documents on a specific date and time due to being unintentionally misplaced, accidentally dropped, stolen, burned, or otherwise damaged and are now considered completely lost. The affiant is swearing to the truth of this statement to secure replacements for the lost items.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    311 views1 page

    Pro Forma Affidavit of Loss

    Uploaded by

    Erin Gamer
    This affidavit details the loss of important documents and items by an individual. It states that the affiant lost their ID card, ATM card, or other documents on a specific date and time due to being unintentionally misplaced, accidentally dropped, stolen, burned, or otherwise damaged and are now considered completely lost. The affiant is swearing to the truth of this statement to secure replacements for the lost items.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines )

    __________________________ ) S.S.

    AFFIDAVIT OF LOSS
    I, _________________________________, of legal age, Filipino, ____________, and a resident
    of _________________________________________________________, after having been duly sworn to
    in accordance with law, hereby depose and state that:

    1. I am employed as ________________________________________ of
    _________________________________________________, a company located at
    ________________________________________________________________________.

    2. On _________________________ 201____ at __________ A.M./P.M., I loss the item/s


    indicated hereunder:

    □ ID Card/s as follows: □ ATM Card/s as follows:

    _____________________________ _____________________________
    _____________________________ _____________________________

    □ Other important document/s as follows:


    _____________________________ _____________________________
    _____________________________ _____________________________

    3. The loss was due to the incident or circumstance cited below:

    □ Item was unintentionally □ Item was accidentally dropped


    misplaced; at ___________________________;

    □ Stolen/Snatched/Robbed □ Item was inadvertently burned/


    at _________________________; disposed of/destroyed/damaged;

    □ Other reason/s: _______________________________________________________


    _______________________________________________________________________
    _______________________________________________________________________.

    4. The above item/s is/are now considered as completely lost and beyond recovery as I
    failed to locate/retrieve the same despite diligent efforts.

    5. I am executing this affidavit to attest to the truth of the foregoing statement and secure
    replacement/s of the lost item/s.

    AFFIANT FUTHER SAYS NONE.

    ____________________________________
    Affiant

    SUBSCRIBED AND SWORN to before me, this _________________________ 20_____, by the


    affiant whom I have identified through his/her Competent Evidence of Identity which is his/her
    ____________________________ ID No. ______________________________ issued on
    _____________________________ at _______________________________________________.

    Doc. No. ______;


    Page No. ______;
    Book No.______;
    Series of 20____.

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