Affidavit of loss is a written statement prepared to notify an institution or another authority about the loss of an original document in order to obtain a replacement. Below is a sample affidavit of loss of GSIS Policy.
Republic of the Philippines)
City of Makati ) S.S.
x---------------------------x
AFFIDAVIT OF LOSS
I, MARIA C. DELA CRUZ, of legal age, married, Filipino citizen, and a resident of 3333 Hormiga Street, Valenzuela, Makati City, after being duly sworn to in accordance with law, depose and state that:
(1) I am a government employee and a member of the Government Service Insurance System (GSIS);
(2) Being a member of the GSIS, I was issued a GSIS Policy Contract under CM-473173;
(3) I used to keep the said Policy Contract in our home;
(4) Recently, I search for the said Policy Contract because my policy already matured but I could no longer find the same;
(5) Said document must have been lost when I transferred residence from Paco, Manila to Poblacion, Makati City;
(6) Despite diligent search and effort to locate the said Policy Contract, the same could not be found such that I now consider it lost beyond recovery;
(7) As such, I am executing this Affidavit of Loss to attest to the foregoing and for any legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of June 2018 in Makati City.
MARIA C. DELA CRUZ
Affiant |
SUBSCRIBED AND SWORN to before me this 8th day of June 2018 in the City of Makati, Philippines, affiant exhibited to me her Unified Multi-Purpose ID CRN-111-222-3333-1 as valid proof of identity.
Doc. No. _____
Page No. _____
Book No. _____
Series of 2018.