Monday, October 15, 2012

How to Make an Affidavit of Loss

Here's a sample of an affidavit I made myself when I loss a government ID. Just fill out the blanks with pertinent information. Those in red are details I left as examples but you should fill those out with your own facts.



AFFIDAVIT OF LOSS

REPUBLIC OF THE PHILIPPINES)
_____________________________ ) S.S.
                                                
I, _______________, Filipino, of legal age, residing at _______________________, after having been sworn in accordance with law hereby depose and state:
        That I am the true and lawful owner of an SSS ID with number _________________. The details of said ID card are as follows:

    NAME        :    _________________________
    SSS Number    :    ________________________ [I have my SSS number committed to memory so this part is convenient to me. If you don't know yours, just leave this blank or replace with other info like perhaps your birthdate-- for SSS IDs).

         
        That the said ID card was stolen;               
       That at around 3:00 in the afternoon on Tuesday, February 7, 2012, I was shopping for a pair of shoes at a Celine boutique shop in SM San Lazaro, and was surprised to find my wallet missing in my bag when I was ready to pay for my purchase;
    That my SSS ID card was in my wallet;

    That I am executing this affidavit to attest to the truth of the foregoing, and to request from SSS, a replacement for my SSS ID card.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of February, 2012  at _______ City.

__________________
Name

                 
        SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___ in ___________________ City, with affiant exhibiting her CTC No. ________. Issued on ________ at _______ City.


NOTARY PUBLIC
                                                                                          Until December 31, 200___

Doc.  No. :  ________;
Page  No. :  ________;
Book No. :  ________;
Series of 20___.

1 comment:

  1. pagnagawa ko na po yan tas na pa print ko po ddalhin ko na po ba sa philhealth office ?? or my kailangn pa po akong pmtahan para ma pa pirma ? plss reply salamAt po

    ReplyDelete