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Affidavit of Lost Check

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Republic of the Philippines )

City of Atlantis ) S.S


X ------------------------------ X

AFFIDAVIT OF LOST CHECK


I, _______________, of legal age, married, and a resident of
___________________, after having duly sworn to an oath hereby declare:

That I am a depositor of _________________;

That sometime in August ___, I issued a check in favor of ____ under


check number ___in the amount of Php___;

That before I was able to hand the check to the payee, I misplaced the same,
and I could not anymore locate it;

That I exerted diligent efforts to locate the same in other places but the
same proved futile and to no avail;

That I hereby declare that the said _____check I issued is lost and beyond
recovery;

That I am executing this affidavit to attest to the truth of the foregoing facts
for whatever legal purposes and intents this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this


____ at ----, Philippines.

______________
Affiant

Signed in the presence of:

SUBSCRIBED AND SWORN TO BEFORE me this, at ____, Affiant


having presented his LTO Driver’s License ID with number ____________ which
will expire on _____ as his competent evidence of identity.

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