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(Insert Name of Party) (Insert Address)

This affidavit of loss details the loss of an item and requests its replacement. It states that [name] was issued an item by [organization] under account number [number]. The item was misplaced during a move and could not be found despite diligent searching. The item was not confiscated or used illegally. As the item is now lost, this affidavit is being submitted to request its replacement. The affidavit was sworn before an assistant on [date] in Cebu City, Philippines.

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Richard Colunga
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177 views1 page

(Insert Name of Party) (Insert Address)

This affidavit of loss details the loss of an item and requests its replacement. It states that [name] was issued an item by [organization] under account number [number]. The item was misplaced during a move and could not be found despite diligent searching. The item was not confiscated or used illegally. As the item is now lost, this affidavit is being submitted to request its replacement. The affidavit was sworn before an assistant on [date] in Cebu City, Philippines.

Uploaded by

Richard Colunga
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU ) S.S.


x- - - - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, (Insert name of party), of legal age, Filipino, single, and a


resident of (Insert address); after having been duly sworn to in
accordance with law, hereby depose and state:

1. Insert name were issued with a (Insert thing lost) by the xxxx ,
location under a Joint Savings Account No. xxxx xxxx xxxx.

2. Sometime in Insert date, said (Insert thing lost) was misplaced and
got lost when I was transferring from one residence to another around
xxxxx;

3. Diligent efforts were exerted to locate said (Insert thing lost), but in
spite of diligent search, it could not be found and the same is now beyond
recovery;

4. Said (Insert thing lost) has not been confiscated by the authorities or
used in violation of the law;

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


the foregoing and to request for a replacement of Said (Insert thing
lost)in lieu of the one that was lost;

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


of ________ 2020 in Cebu City, Philippines.

(Insert name of party)


(Affiant)
____________________
____________________

SUBCRIBED AND SWORN TO before me this ___th day of ________


2020 in Cebu City, Philippines, affiant, who presented his competent
evidence of identity bearing the aforementioned details, who personally
signed the foregoing instrument before me and avowed under penalty of
law to the whole truth of the contents of said instrument.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 2020.

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