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Pawnshop
REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF _____ ) S.S.
x-------------------------------------x
AFFIDAVIT OF LOSS
I, ___________________, of legal age, Filipino, single and a resident of
_______________________________, after having been duly sworn to in accordance with law,
depose and state THAT:
1. Sometime on ______________, I pawned my _________ with Tambunting Pawnshop located
at _____________________ and for which I was issued Pawn Ticket/Receipt No. _________;
2. I kept the said pawn ticket in my wallet for safekeeping but unfortunately my wallet got lost;
3. Despite diligent search and efforts to locate the said wallet and pawn ticket, I could not find
the same such that I believe that they are now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and to enable me to secure
a duplicate or substitute copy of the ticket and/or redeem the above-described item which I
pawned.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in
____________, Philippines.
____________________
Affiant
GSIS ID No. _____________
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in
_________________, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.
Passport
REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI
) S.S.
x----------------------------------x
AFFIDAVIT OF LOSS
I, ___________________, of legal age, Filipino, single and a resident of
_______________________________, after having been duly sworn to in accordance with law,
depose and state THAT:
1. On January 12, 2010, I was issued a Philippine Passport by the Department of Affairs in Manila;
2. Recently, I had tried to look for the said passport but the same could not be found;
3. Despite diligent search and efforts to locate the said passport, I could not find the same such that I
believe that it is now lost beyond recovery;
4. As such, I am executing this affidavit to attest to the foregoing facts and to support
the application for the issuance of a new one in lieu of the one which was lost.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in
Makati City, Metro Manila, Philippines.
____________________
Affiant
GSIS ID No. _____________
SUBCRIBED
AND
SWORN
TO before
me
this ___________________ in
_________________, Philippines, affiant exhibiting to me his valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.