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Sample Affidavit of Loss

An Affidavit of Loss contains essential parts including the title, affiant's personal details, a narration of the circumstances of the loss describing the lost item and efforts to find it, the affiant's signature, and a jurat sworn before a notary public. The document should be notarized, printed in multiple copies, and brought to a notary who will confirm the affiant's identity before notarizing. An Affidavit of Loss is used to request a replacement of a lost document and must be truthful otherwise it could result in perjury charges.

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499 views2 pages

Sample Affidavit of Loss

An Affidavit of Loss contains essential parts including the title, affiant's personal details, a narration of the circumstances of the loss describing the lost item and efforts to find it, the affiant's signature, and a jurat sworn before a notary public. The document should be notarized, printed in multiple copies, and brought to a notary who will confirm the affiant's identity before notarizing. An Affidavit of Loss is used to request a replacement of a lost document and must be truthful otherwise it could result in perjury charges.

Uploaded by

Ferlene
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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An Affidavit of Loss contains the following essential parts:

1. Title of the document


2. Your name, statement that you are of legal age, civil status, citizenship, and residence address. 
3. A narration of the circumstances of the loss, which includes (i) a description of the item or document lost;
(ii) a description of how it got lost; (iii) the effort exerted to find it; and (iv) your request for a replacement
of the item or document lost.
4. The signature of the affiant. Affiant is the person executing/signing the document.
5. The jurat. The jurat is the oath or affirmation before the notary public that you have personally executed
the document in the presence of the notary.

2. Print at least three copies of the document


 The notary public will retain one copy.
 One copy goes to the office where you’ll submit the document.
 One copy goes to you, for your file.

3. Go to the notary public to have the document notarized


Do not forget to bring a valid ID to the notary as the latter will have to confirm your identity.

Tips and Warnings


 Some government offices and private institutions (e.g., banks) have their own Affidavit of Loss template so it is
best to check their website first and use their template to save you time. Once you fill out their pro forma template,
you may bring the same to the notary.
 

Frequently Asked Questions


1. Should Affidavit of Loss be notarized?
Yes. Affidavit of Loss should be notarized. An affidavit is a legal document executed under oath which means you are
attesting to the whole truth of the contents of your affidavit. That is the purpose of the jurat, which starts which the
words “SUBSCRIBED AND SWORN TO..”

If your statement is false, you can be prosecuted for the crime of perjury. 

2. I don’t have an ID because I lost it. Will the notary public notarize my
document?
Yes. the notary public will notarize your document if your situation
falls into any of the following: 

 The notary public personally knows you;


 The notary public does not know you, but one credible witness who is personally known to the notary public can
confirm your identity;
 If you can bring two credible witnesses who have IDs and they can confirm your identity to the notary.

3. How much is the Affidavit of Loss in the Philippines?


The going rate for notarization of Affidavit of Loss usually starts at Php 100. The cost varies depending on the place
and the notary public itself. 

4. Can I get a free Affidavit of Loss?


Yes. If you are indigent, you may be able to get your Affidavit of Loss notarized for free at the Public Attorney’s Office
as the latter offers notarial services to indigent persons.

To be considered indigent, your family income should not exceed Php 14,000 per month if you are residing in Metro
Manila, Php 13,000 for other cities, and Php 12,000 for all other places. 

You may check the Legal Office or the City Councilor Office of your city or municipality as they sometimes offer free
notarial services to their constituents.

5. How long is the validity period of the Affidavit of Loss? Does it expire?
Affidavit of Loss has no specific expiry date, but it is only valid for the specific incident where you lost the document,
so you can only use it once. It means once you obtained a replacement of the lost document and you lost it again,
you’ll have to execute another Affidavit of Loss and not use the previous one.

6. I lost my bag containing several documents and IDs. Should I execute one
Affidavit of Loss for each item/document lost, or can I execute just one
affidavit for all?
You do not need to make one Affidavit of Loss for each. One affidavit for all will suffice. 

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