Вы находитесь на странице: 1из 1

REPUBLIC OF THE PHILIPPINES }

QUEZON CITY } S.S.

AFFIDAVIT OF LOSS

I, EVELYN ESTRADA DIAZ, of legal age, Filipino, married to LORENZO


LADREDA DIAZ and with residence address at 46-B 19th Ave., San Roque, after
having been duly sworn to in accordance with law hereby depose and state:

1. That I am the owner/possessor of AFPSLAI ID;

2. That sometimes in July 2019, I was looking for the above mentioned
AFPSLAI ID inside my house but the same could no longer be located, it
appears that the same was already lost or might have been misplaced due
to unknown circumstances;

3. That despite diligent efforts to locate the above-mentioned items, all efforts
to locate the same remain futile up to the present, I have not located the
same and fear that the same is considered lost beyond recovery;

4. That 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 19th day of


September 2019, at Quezon City, Philippines.

`
AIREEN C. COLONGON
Affiant

SUBSCRIBED AND SWORN to before me this 19th day of September 2019,


at Quezon City, affiant exhibited to me his/her ID with No. ___________________.

NOTARY PUBLIC

Doc. No. ____


Page No. ____
Book No. ____
Series of 2019.