Sample Affidavit of Loss of Passbook

REPUBLIC OF THE PHILIPPINES)

CITY OF MAKATI            ) S.S.

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

  

AFFIDAVIT OF LOSS

 I, ___________________, of legal age, Filipino, (single/married/widow) and a resident of _______________________________, after having been duly sworn to in accordance with law, depose and state THAT:

1. I maintain a Savings Account with S/A No. _____________ with _____________ Bank with a credit balance of _____________ (P_____________);

2. Sometime on ____________, the passbook of the above-mentioned account was lost in the following manner:

    ___________________________________________________

    ___________________________________________________

3. Despite diligent efforts exerted, I could no longer locate, find or recover the said passbook, and to the best of my knowledge, the same is truly lost;

4. In view thereof, I now desire and hereby request ______ Bank to issue another passbook in lieu of the lost one and I am willing to surrender the lost passbook in the event that the same could be found;

5. As such, I am executing this affidavit to attest to the foregoing facts and to support the application for the issuance of a new passbook in lieu of the one which was lost. 

IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in Makati City, Metro Manila, Philippines.

____________________ Affiant SSS ID No. _____________

        SUBCRIBED AND SWORN TO before me this ___________________ in _________________, Philippines, affiant exhibiting to me his/her competent evidence of identity by way of __________________ issued at ______________ on __________________.

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2013.