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    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 ManilaPhilippines.





    ____________________
    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.

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