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Affidavit of Loss New RFID

Jose Pedro filed an affidavit of loss to report that he lost his Autosweep RFID cards with tag numbers XXXXX – ABC000 and XXXXXXX – GHI111. In the affidavit, he states that he is the owner of the lost cards under his Autosweep account with account number 000000. Despite his efforts, he was unable to find the lost items. He executed the affidavit to attest to the truth of his account of the loss and to request replacement cards from the authorities. The affidavit was notarized on a specified date in the city where Pedro resides.

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Dixie Imperial
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363 views

Affidavit of Loss New RFID

Jose Pedro filed an affidavit of loss to report that he lost his Autosweep RFID cards with tag numbers XXXXX – ABC000 and XXXXXXX – GHI111. In the affidavit, he states that he is the owner of the lost cards under his Autosweep account with account number 000000. Despite his efforts, he was unable to find the lost items. He executed the affidavit to attest to the truth of his account of the loss and to request replacement cards from the authorities. The affidavit was notarized on a specified date in the city where Pedro resides.

Uploaded by

Dixie Imperial
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/Municipality of _____________)
x-------------x

AFFIDAVIT OF LOSS

I, JOSE PEDRO, Filipino, of legal age, single, and residing at Alabang, Muntinlupa City, after
having been sworn to in accordance with law hereby and state:

I am holder/owner/ or possessor of the following identification card / document: Autosweep


RFID Card with Tag Number XXXXX – ABC000 and XXXXXXX – GHI111 under the Account Name of JOSE
PEDRO with Account Number 000000;

I have recently discovered the said item is irretrievably lost and can no longer be found despite
diligent efforts to locate the same;

That I am executing this affidavit to attest the truth of the foregoing and to request the
authorities concerned for the replacement of the item lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ day of _____________
at ________________________

JOSE PEDRO
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _________________, 20 ____ in


____________________ City, with affiant exhibiting his/her CTC No. ___________________, issued on
__________________________ at _______________________.

NOTARY PUBLIC

Doc. No. : ______________;


Page No. : ______________;
Book No. : ______________;
Series of 20________.

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