Uploaded by Mark Clemente

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tRepublic of the Philippines}
City
of
Makati} S.S.
AFFIDAVIT OF LOSS
AFFIDAVIT OF LOSS
I, JOEBERTO E. EJANDRA
,
of legal age, married, with residence and
postal address at
Blk. 54 Lot 21, Duhat St., Zone 1 Brgy. Rizal, Pembo, Makati City,
after being sworn to in accordance with law, depose and say that:
1) I am an employee of
ASIATRANS INTERNATIONAL, INC. (AII),
with office
address at the
6
th
Floor, Country Space 1 Bldg., Sen. Gil Puyat Avenue, Makati City;
2)
As such, I was provided by our employer with several Identification Cards such as
our Company ID, PHILHEALTH ID, BPI ATM CARD and I was likewise required to procure
our SSS Identification Card
;
3) In my everyday way to and from the office, I used to drive my personal service
motorcycle with my wallet tucked in the back pocket of my pants;
4) However, last December 16, 2005, after arriving from office, I was just surprised
to have known that my wallet containing all my important IDENTIFICATION CARDS, was
already missing as it might have accidentally fell-off from the back-pocket of my pants then
while I was driving my motorcycle on my way to office during that day;
5) Diligent efforts have already been exerted to locate and/or retrieve my wallet
along with my IDs, but all turned out futile;
6) I have to request for the re-issuance of these new IDENTIFICATION CARDS
(SSS ID, PHILHEALTH ID, ATM CARDS, CREDIT CARDS, etc.) in furtherance of my
personal transactions and such other business transactions which may require
the
presentation of those aforementioned missing IDs;
7) This affidavit is being executed to attest to the veracity of the foregoing facts and
for whatever legal purpose it may serve.
AFFIANT FURTHER SAYETH NAUGHT.
December 21, 2005, Makati City
.
JOEBERTO E. EJANDRA
JOEBERTO E. EJANDRA
Affiant
SUBSCRIBED AND SWORN
to before me this ___ day of ______________ at
____________, Philippines, affiant exhibiting to me his CTC #
_________________
, issued at
Makati
City
, on
____________________
.
NOTARY PUBLIC
DOC. NO._____;
PAGE NO._____;
BOOK NO._____;
SERIES OF 2005.
Republic of the Philippines}
City
of
Makati} S.S.
AFFIDAVIT OF LOSS
AFFIDAVIT OF LOSS
I, EDRALYN T. SUMALINOG
,
of legal age, single, with residence and postal address at
# 57 Iba St., Dapitan, Quezon City,
after being sworn in accordance with law, depose and say that:
1) I am an employee of
RAYOMAR MANAGEMENT, INC.,
with office address at the
10
th
Floor,
Country Space 1 Bldg., Sen. Gil Puyat Avenue, Makati City;
2)
As such,
I was provided by our employer with several Identification Cards such as
our Company ID, PHILHEALTH ID
, BPI ATM CARD
and I was likewise required to procure our
SSS Identification Card
;
3) In my everyday way to and from the office, I used to commute in Public Utility Vehicles such as
jeepney, bus and/or Light Rail Transit (LRT), carrying my office handbag containing my valuables including
my wallet which in turn contains the aforementioned IDENTIFICATION CARDS ;
4) However, sometime in the later week of March 2005, after arriving from office, I was just
surprised to have known that my wallet containing all my important IDENTIFICATION CARDS, was already
missing as it might have been forcibly taken out from my bag which was then slashed on its upper right side
corner ;
5) Diligent efforts have already been exerted to retrieve my wallet along with my IDs, but all turned
out futile, as the same might had accidentally fell or could have been snatched from my pocket when I
boarded a jeepney/LRT on my way home that day;
6) I have to request for the re-issuance of these new IDENTIFICATION C
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