Affidavit of Loss

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF [CITY/MUNICIPALITY] ) S.S.

AFFIDAVIT OF LOSS

I, [FULL NAME], of legal age, [CIVIL STATUS], [CITIZENSHIP], with residence and postal address at [ADDRESS], after having been duly sworn in accordance with law, depose and state that:

1. I am the [OWNER/HOLDER/REGISTERED OWNER] of the following [DOCUMENT/ITEM] (the "Lost Item"): [DESCRIPTION OF LOST ITEM — type, serial or reference number, issuing office, date of issue];

2. On or about [DATE], at around [TIME], at [PLACE], I discovered that the Lost Item was missing. The circumstances of the loss are as follows: [NARRATE THE FACTS IN THE FIRST PERSON — where the Lost Item was last kept or seen, how and when the loss was discovered];

3. Immediately after discovering the loss, I made diligent efforts to locate the Lost Item, namely [DESCRIBE THE SEARCH — retracing steps, inquiring with persons or offices concerned], but despite these efforts it can no longer be found, and I believe that it is now beyond recovery;

4. The Lost Item has not been sold, assigned, pledged, mortgaged, or otherwise transferred or encumbered by me, and it has not been delivered to any person as security for any obligation;

5. [OPTIONAL: I reported the loss to [POLICE STATION/OFFICE] on [DATE], as shown in the [POLICE BLOTTER ENTRY/REPORT] No. [NUMBER], a copy of which is attached as Annex "A";]

6. Should the Lost Item be found or recovered, I undertake not to use it and to surrender it immediately to [ISSUING OFFICE/AGENCY];

7. I am executing this affidavit to attest to the truth of the foregoing and to support my request for [PURPOSE — e.g., the issuance of a replacement/duplicate [DOCUMENT] by [AGENCY]], and for whatever other lawful purpose it may serve.

I am aware that a false statement made under oath in this affidavit may expose me to criminal liability for perjury.

IN WITNESS WHEREOF, I have signed this affidavit this [DAY] day of [MONTH] 2026 at [CITY/MUNICIPALITY], Philippines. ______________________________ [FULL NAME] Affiant

SUBSCRIBED AND SWORN TO before me this [DAY] day of [MONTH] 2026 at [CITY/MUNICIPALITY], Philippines, by the affiant, who personally appeared before me, signed the foregoing affidavit in my presence, and exhibited to me competent evidence of identity bearing [HIS/HER] photograph and signature, namely, [ID TYPE] No. [ID NUMBER] issued on [DATE OF ISSUE] by [ISSUING AGENCY] [valid until [EXPIRY DATE]]. The affiant took an oath before me as to the truth of the contents of this affidavit. Doc. No. ______; Page No. ______; Book No. ______; Series of 2026. __________________________________ [FULL NAME OF NOTARY PUBLIC] Notary Public for [CITY/PROVINCE] Notarial Commission No. [NUMBER] Commission valid until December 31, [YEAR] Roll of Attorneys No. [NUMBER] PTR No. [NUMBER]; [DATE]; [PLACE OF ISSUE] IBP No. [NUMBER]; [DATE]; [CHAPTER] MCLE Compliance No. [NUMBER]; [DATE] Office: [OFFICE ADDRESS OF NOTARY]

DRAFTING NOTES FOR THE LAWYER — delete this page before printing

• Notarial act: jurat (2004 Rules on Notarial Practice, A.M. No. 02-8-13-SC, Rule II, Sec. 6). The affiant must appear in person, sign in the notary’s presence, and be personally known or identified by competent evidence of identity (Rule II, Sec. 12, as amended 19 Feb 2008; Rule IV, Sec. 2(b)). A community tax certificate (cedula) is not competent evidence of identity.

• Lost owner’s duplicate certificate of title: an affidavit is not enough. P.D. No. 1529, Sec. 109 requires a sworn notice to the Register of Deeds and a court petition for a new owner’s duplicate. Adapt paragraph 7 accordingly.

• Agencies (DFA for passports, LTO for licenses/OR-CR, PSA, banks, schools) often prescribe extra requirements (police report, personal appearance, waiting periods). Check the agency’s current Citizen’s Charter before execution.

• Perjury: Revised Penal Code, Art. 183. Keep the narrative factual and in the affiant’s own words.

• Since 21 June 2025 (amendments to the 2004 Rules, En Banc Resolution of 4 March 2025): the notary keeps a full-colour PDF duplicate, sends it to the Clerk of Court with the monthly report through the registered professional e-mail, and sends an e-copy to the signatory within five days unless waived. Verify against the official text.

Field labels in [SQUARE BRACKETS, CAPITALS] must be completed or deleted. Alternatives are separated by a slash (e.g., [HIS/HER]). © Layers (layers.md), licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). You may adapt and reuse this template with attribution. Template — review by a Philippine lawyer before use. Not legal advice.

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