Nothing Special   »   [go: up one dir, main page]

AFFIDAVIT OF LOSS Sim Card

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

REPUBLIC OF THE PHILIPPINES)

City/Municipality of _____________) S.S.


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

AFFIDAVIT OF LOSS

I, PAMELA I. CLAUDIO, Filipino, of legal age with an address at 39 Visayas St. Filipinas
Village, Brgy. Malanday, Marikina City, Philippines, after being duly sworn in accordance with
law, depose and state:

1. That I am a regular student of La Consolacion College Manila with a course of BS


Psychology;

2. That in the afternoon of Februrary 27, 2019, while aboard a tricycle going home, my
school id with No. 201800-1018 in La Consolacion College Manila got lost;

3. That I have reported this incident to the Barangay police and to the Homeowner’s
Association;

4. That despite diligent search and efforts to locate said school ID, I could not find the
same such that I now believe that said is now lost beyond;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and in
support of my request / application for the replacement of the said School ID Card and
for whatever purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at


_____________, Philippines.

PAMELA I. CLAUDIO
AFFIANT
ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of _____________, personally appeared
_____________ ID No. _____________ issued on _____________ at _____________, personally known to me (or
whom I have identified through competent evidence of identity) and who represented to me that his/her signature on
the foregoing instrument was voluntarily affixed by him/her for the purposes stated in the instrument and who
declared that he/she has executed the foregoing instrument as his/her free and voluntary act and deed.

WITNESS MY HAND AND SEAL this _____________ at _____________, Philippines.

NOTARY PUBLIC

Doc. No. ______;


Page No. ______;
Book No.______;
Series of 20____.

You might also like