You are on page 1of 2

REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S.S.

AFFIDAVIT OF LOSS
I, ALBERTO CELSO C.
legal age, with postal address
Road 1, Project 6, Quezon
sworn to in accordance with
state:

VICTORIA, JR., Filipino, of


at No. 2K Unit 5 Alley 27
City, after having been duly
law, do hereby depose and

1. That I was DULY issued with AMWSLAI (Air


Materiel Wing Savings and Loan Association Inc.)
Passbook/Policy;
2. That sometime on 2010, the afore-stated effect was
mislaid in our house or had been inadvertently
trashed by someone who has no knowledge of its
importance;
3. That unfortunately, however, despite diligent and
exhausted efforts exerted, the same could no longer
be recovered;
4. That for this reason, I am declaring and considering
my aforesaid effects as lost beyond recovery; and
5. I have executed this Affidavit to attest to the truth
and veracity of all the foregoing for all legal intents
and legitimate purpose this may serve.
Affiant further sayeth naught.
IN WITNESS WHEREOF, I have hereunto set my
hand and affixed my signature on this 03rd day of October,
2013, in Quezon City, Metro Manila, Philippines.

ALBERTO CELSO C. VICTORIA,


JR.
Affiant
SUBSCRIBED AND SWORN to before on the date
and place above-written.

Doc. No._____;
Page No._____;
Book No._____;
Series of 2013.

You might also like