Você está na página 1de 1

REPUBLIC OF THE PHILIPPINES)

CITY OF BATANGAS
)S.S.

AFFIDAVIT OF LOSS
I, EDENA A. MELO, of legal age, married, Filipino citizen and with residence and
postal address at Melos Coumound, Alangilan, Batangas City, after having been sworn
to in accordance with law hereby deposes and states that:
1. My mother, CORAZON R. ATIENZA, is a holder/bearer of Senior Citizens
Identification Card and a Original Certificate of Live Birth
2. Being her daughter, I was entrusted by her to safekeep her Senior Citizens
Identification Card and Original Certificate of Live Birth;
3. I placed above-mentioned identification card and Certificate of Live Birth
inside our filing cabinet at home where I am usually putting all my important
documents and receipts;
4. Just recently, when I was about to get said identification card and Certificate
of Live Birth, the same cannot be found on the place where I last put it,
probably having been loss due to neglect of its safekeeping;
5. Despite diligent efforts made to locate said identification card and Certificate
of Live Birth the same could not be found and now deemed irretrievably loss;
6. I am executing this Affidavit of Loss to attest the truthfulness of the foregoing
facts and further for whatever legal purpose it may serve.
FURTHER AFFIANT SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this 11 th day of February
2015.

EDENA A. MELO
Affiant
SUBSCRIBED AND SWORN TO before me this 11th day of February 2015 at
Batangas City, Philippines, affiant presenting to me her Voters Identification No. 10050070B-K2359EAM20000.

Doc. No. 465A;


Page No. 94;
Book No. II;
Series of 2015.

/var/www/apps/conversion/tmp/scratch_2/342350595.docx

Você também pode gostar