Affidavits2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC); Revised Penal Code Art. 183 (False Testimony & Perjury).

Affidavit of Loss

Sworn statement attesting to the unintentional loss of an official document, ID card, ATM card, or certificate of title.

Replace bracketed text [LIKE THIS] with your actual information

REPUBLIC OF THE PHILIPPINES) CITY/MUNICIPALITY OF ________ ) S.S. AFFIDAVIT OF LOSS I, [FULL NAME OF AFFIANT], of legal age, Filipino, [single / married / widow], and a resident of [COMPLETE RESIDENTIAL ADDRESS], after having been duly sworn to in accordance with law, hereby depose and state that: 1. I am the lawful holder/owner of a certain [NAME OF DOCUMENT/ITEM, e.g., Driver's License / ATM Card / PRC ID], issued by [ISSUING AGENCY/BANK] under [ID/ACCOUNT/LICENSE NUMBER, if known]; 2. On or about [DATE OF LOSS], the said [DOCUMENT/ITEM] was misplaced and lost under the following circumstances: [BRIEFLY NARRATE CIRCUMSTANCES, e.g., while commuting along EDSA on a public bus / misplaced inside my wallet which went missing / during transit from my home to work]; 3. Diligent and earnest efforts were exerted by me to locate and recover the said [DOCUMENT/ITEM], but all such efforts proved futile and unsuccessful, such that the same is now considered lost beyond recovery; 4. The said [DOCUMENT/ITEM] has not been confiscated by law enforcement or any court of law, nor has it been transferred, pledged, or encumbered to any third person or entity as security for any obligation; 5. I am executing this Affidavit to attest to the truth of the foregoing facts and for the purpose of securing a replacement copy of the said [DOCUMENT/ITEM] from [ISSUING AGENCY/BANK], and for whatever legal purpose it may serve. IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________, 20___, in the City/Municipality of ________________________, Philippines. ________________________________________ [SIGNATURE OVER PRINTED NAME] Affiant SUBSCRIBED AND SWORN to before me this _____ day of _______________, 20___, in the City/Municipality of ________________________, Philippines, affiant exhibiting to me their Competent Evidence of Identity: [TYPE OF ID, e.g. Philippine Passport / PhilSys National ID] with ID No. ________________________, valid until ________________________. Doc. No. _______; Page No. _______; Book No. _______; Series of 20___.

When to Use

Required by government agencies (LTO, PRC, DFA, PSA) and banks to issue a replacement for a lost Driver's License, Passport, ATM card, or Official Receipt.

Legal Basis2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC); Revised Penal Code Art. 183 (False Testimony & Perjury).

Execution & Notarization

Print at least two (2) original copies on standard legal (8.5" x 13" or 8.5" x 14") or letter paper.
Fill in the bracketed blanks with your exact personal and document details.
DO NOT sign the document at home. You must sign in the presence of a licensed Notary Public.
Bring one (1) valid government-issued photo ID (e.g. Passport, UMID, National ID, Voter's ID) showing your full name and signature as Competent Evidence of Identity.
Pay the notarial fee and ensure a ₱30 BIR Documentary Stamp (DST) is affixed to the document.
Keep one notarized copy for your personal records and submit the other to the issuing agency.

Disclaimer: This template is provided for educational and administrative guidance only. Laws, local court rules, and agency guidelines vary. Consult a qualified Philippine lawyer or the Public Attorney's Office (PAO) for case-specific advice.