QUEZON CITY, METRO MANILA } S.S. AFFIDAVIT OF LOSS I, (Emp# ________________) __________________________, of legal age, Filipino, with residence and postal address at __________________________________ ____________, after having been duly sworn to in accordance with law hereby depose and state that: 1. 2. 3. 4.
5. 6. 7.
I am presently employed with <company> <branch> _______________
as ________________________ (position); By virtue of my employment, I was issued an Identification Card; Said Identification Card was lost sometime on ____________________ at ____________________________; Hereunder are the facts and circumstances surrounding the loss of my Identification Card: _________________________________________________________ _________________________________________________________ _________________________________________________________ I made diligent search to recover the said Identification Card but proved futile; For all legal intents and purposes the said Identification Card is now considered lost and beyond recovery; I am executing this affidavit to attest to the truth of the foregoing and for whatever legal purpose/s it may serve.
FURTHER AFFIANT SAYETH NAUGHT.
IN TRUTH THEREOF, I have hereunto set my hand this _____________ day of ___________________20__, at __________________________, Philippines. __________________ Affiant SUBSCRIBED AND SWORN to before me this ___________________ day of ______________________ 20__ , affiant exhibited to me his/her Residence Cert. No. __________________ issued at ___________________ on ______________________. NOTARY PUBLIC Doc. No. ___________; Page No. ___________; Book No. ___________; HF-HRD-AOL