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Affidavit of Loss: Benedicta B. Mempin

Benedicta B. Mempin executed an affidavit of loss regarding her late husband Arnulfo S. Mempin's life insurance policy with KCFAPI Insurance of Knights of Columbus. She attests that her husband passed away in December 2013, they have been unable to locate the policy after searching, and considers the policy lost. She signs the affidavit to legally establish the loss of the policy.

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Yolly Tagiobon Lèbanon
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35 views1 page

Affidavit of Loss: Benedicta B. Mempin

Benedicta B. Mempin executed an affidavit of loss regarding her late husband Arnulfo S. Mempin's life insurance policy with KCFAPI Insurance of Knights of Columbus. She attests that her husband passed away in December 2013, they have been unable to locate the policy after searching, and considers the policy lost. She signs the affidavit to legally establish the loss of the policy.

Uploaded by

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

CITY OF GENERAL S A N T O S) S.S.


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

AFFIDAVIT OF LOSS

I, BENEDICTA B. MEMPIN, of legal age, Filipino, widow and a resident of


Kiamba, Sarangani Province, after having been duly sworn to in accordance with law, do
hereby depose and say:

1. That I am the surviving wife of the late ARNULFO S. MEMPIN who died on
December 8, 2013 at Kiamba, Sarangani Province;

2. That my husband is a policy holder of KCFAPI Insurance of Knights of


Columbus;

3. That just recently, as we look over for the said Policy, we could not find it;

4. That diligent efforts exerted to recover said Policy proved futile as the same
could not be found and is now considered lost;

5. That I am executing this affidavit to attest to the truth of the foregoing facts and
for whatever purpose this may legally serve.

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


General Santos City.

BENEDICTA B. MEMPIN
Affiant
OSCA ID No. 003500

SUBSCRIBED AND SWORN to before me this __________________ at General


Santos City, affiant exhibiting to me her competent evidence of identity bearing her
photograph and signature.

Doc. No. ____________;


Page No. ____________;
Book No.____________;
Series of 2014.

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