Professional Documents
Culture Documents
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AFFIDAVIT OF LOSS
I, ______________________________________________ of legal age,
Filipino and a resident of _____________________________________ under
oath state:
1. That I am a bonafide holder of the following identification /
PRC license / POSB ATM Card duly issued by the involved
office / bank / entity / commission as follows:
a. PRC License ID No. ________________ as a licensed /
registered nurse issued by the Philippine Regulation
Commission (PRC);
b. POSB ATM Card
c. Parkway Shenton PTE LTD Healthcard
2. That the said identification / PRC license / POSB ATM Card
were kept in my wallet together with my other identification
and pertinent documents;
3. That sometime on ___________________________ I found out
that my wallet (where the said identification / license / POSB
ATM Card were kept) got lost , believing it might have fallen
without my awareness or might have been misplaced
somewhere else during my travels;
4. That I exerted utmost effort to seek and recover the said
identification / PRC license / POSB ATM Card but it only
proved futile, as such it is now deemed lost beyond
recovery;
5. That I am executing this affidavit to attest to the truth of the
foregoing, to inform the concerned agencies / offices /
commission about the lost of my said identification / PRC
license / POSB ATM Card and for whatever legal purposes
this affidavit may serve best.
IN WITNESS WHEREOF, I hereunto affixed my signature this day
of ____________ at ___________________________________________.
_________________________________
Affiant
ID No: _____________________
Issued by: _________________
AFFIDAVIT OF LOSS
I, ADONIS JESS P. PAGDILAO, of legal age, single, Filipino and a resident of
Brgy. Loctugan, Roxas City, Capiz under oath state:
2. That the said PRC ID was kept in my wallet together with my other
important and pertinent document;
3. That on September 29, 2012, when I looked for my said PRC ID, I
noticed that the same is nowhere to be found and could not be
located believing it might have fallen or misplaced somewhere else;
4. That I exerted utmost effort to seek and recover my said drivers
license but it only proved futile, as such that it is now deemed lost
beyond recovery;