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    Lost ID (Accidentally) Version 2

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    Joshua C. Castillo

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    © All Rights Reserved
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    Lost ID (Accidentally) Version 2

    Uploaded by

    Joshua C. Castillo
    5 views2 pages

    Copyright

    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    5 views2 pages

    Lost ID (Accidentally) Version 2

    Uploaded by

    Joshua C. Castillo

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    AFFIDAVIT OF LOSS FORM

    (ID, Passport, Passbook etc.)


    Requirements: Government Issue Valid ID, NBI Clearance or Passport
    Date: Friday, June 11, 2021

    PERSONAL DETAILS
    NAME: Juan dela cruz
    SEX: his
    BIRTHDATE:
    MARITAL STATUS single
    ADDRESS:
    PARENTS
    FATHER Name:_______________________________ ☐ Alive ☐ Diseased
    MOTHER Name:_______________________________ ☐ Alive ☐ Diseased
    PARENT MARITAL ☐ Married ☐ Single ☐ Annulled
    STATUS

    LOST DOCUMENT
    DOCUMENT TYPE
    ISSUING
    COMPANY/OFFICE
    DOCUMENT NUMBER
    DATE OF LOSS:
    ADDITIONAL DETAILS ☐ Lost ☐ Stolen ☐Uncertain ☐Others:_____
    OTHER REMARKS
    ID PRESENTED
    ID TYPE
    ID NUMBER
    DATE OF ISSUANCE
    DATE OF EXPIRATION
    PLACE OF ISSUANCE

    CommandButton1

    Republic of the Philippines) s.s.


    Pulilan, Bulacan )

    AFFIDAVIT OF LOSS

    I, Juan dela cruz Juana Santos, of legal age, single, Filipino and residing at Balatong B,
    Pulilan, Bulacan after having been duly sworn to in accordance with law hereby depose and say:

    That, I am the lawful holder of a Professional Driver’s License issued by the Department
    of Transportation and Communication with office address at Guiguinto, Bulacan;

    That, said Professional Driver’s License was accidentally lost last and despite diligent
    effort to locate it the same proved futile and in vain;

    That, said Professional Driver’s License has never been confiscated nor surrender to any
    lawful authorities;
    That, I executed this affidavit to attest to the veracity of the statement above given and to
    request the authorities concern to issue a new one after payment of the corresponding fees;

    IN WITNESS WHEREOF I, have hereunto affixed my signature this 11 June 2021


    hereat Pulilan, Bulacan.

    JOSE REYES
    Affiant

    SUBSCRIBED AND SWORN to before me in the Municipality of Pulilan, Bulacan this


    11 June 2021 by Ernest A. Santos with his Voter’s Cert. with No. 1418300024244 as his
    competent evidence of identity and who personally signed the foregoing Affidavit before me
    and acknowledged that he executed the same.

    RENAN B. CASTILLO
    Doc. No. 9 : Notary Public for and in the
    Page No. 7: Province of Bulacan
    Book No. 5 : 541 Poblacion, Pulilan, Bulacan
    Series 2021 : PNC-35-MB-2017
    PTR No. 9977260 – 1.3.18
    IBP O.R. No. 024206 – CY 2018
    Roll of Attorneys No. 30011
    MCLE Compliance No. VI-0002591
    dated June 20, 2017
    My Commission Expires on December 31, 2019

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