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Affidavit of Loss Sample

1. Cedie C. Sedillo filed an affidavit of loss stating that she lost her employee ID, ATM debit card, and PhilHealth ID. 2. She is a part-time employee of MCDO Consolacion and electromechanics student at CITE in San Jose, Cebu City. 3. On April 8, 2016, her wallet containing the IDs and debit card was lost after her bag, which was in her locker, was opened. She has been unable to locate the lost items despite her efforts.

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186 views2 pages

Affidavit of Loss Sample

1. Cedie C. Sedillo filed an affidavit of loss stating that she lost her employee ID, ATM debit card, and PhilHealth ID. 2. She is a part-time employee of MCDO Consolacion and electromechanics student at CITE in San Jose, Cebu City. 3. On April 8, 2016, her wallet containing the IDs and debit card was lost after her bag, which was in her locker, was opened. She has been unable to locate the lost items despite her efforts.

Uploaded by

KriziaItao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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REPUBLIC OF THE PHILIPPINES)

CITY OF MANDAUE.)S.S.

AFFIDAVIT OF LOSS
I, CEDIE C. SEDILLO, of legal age, Filipino, single and a resident of Centro
Maguikay, Mandaue City, after having been duly sworn to in accordance with law,
hereby depose and state that:`
1. I am a part-time employee of MCDO Consolacion, Cebu;
2. I was issued the following, to wit:
2.1.

An employee ID issued by the above-mentioned company;

2.2.

An ATM Debit Card issued by BDO Company; and

2.3.

A PhilHealth ID;

3. I am an Electromechanics student of CITE, San Jose, Cebu City;


4. Sometime on April 8, 2016 at around 12 o clock in the afternoon, after my
classes, my bag which was inside the locker was opened. Consequently, my
wallet was lost contain
5.
6. ing the above-mentioned IDs and ATM Debit Card;
7. The above-mentioned IDs and ATM Debit Card can no longer be found
notwithstanding of all efforts to locate it;
8. I am executing this affidavit to attest the veracity of the foregoing
statements and for the re-issuance of the above-mentioned IDs and ATM
Debit Card and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 18 th day of April


2016, at Mandaue City, Cebu.

CEDIE C. SEDILLO
Affiant
CTC No. 12638279

SUBSCRIBED AND SWORN TO before me this 18th day of April 2016 at


Mandaue City, Philippines, affiant being personally known to me and exhibiting his

Community Tax Certificate with number CTC No. 12638279 as competent evidence
of identity.

Doc No. ______;


Page No. ______;
Book No. ______;
Series of 2016.

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