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Affidavit of Loss Receipt

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Junnel Cañete

This affidavit of loss was sworn by [name redacted] who lost an official receipt issued by [organization redacted] with receipt number [number redacted] for [name redacted]. The affidavit states that the receipt was accidentally left in an envelope in a tricycle in downtown [location redacted]. Despite efforts to retrieve it, the receipt could not be found and is considered lost. The affiant declares the information in the affidavit is true to the best of their knowledge.

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Affidavit of Loss Receipt

Uploaded by

Junnel Cañete
132 views1 page
This affidavit of loss was sworn by [name redacted] who lost an official receipt issued by [organization redacted] with receipt number [number redacted] for [name redacted]. The affidavit states that the receipt was accidentally left in an envelope in a tricycle in downtown [location redacted]. Despite efforts to retrieve it, the receipt could not be found and is considered lost. The affiant declares the information in the affidavit is true to the best of their knowledge.

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affidavit of loss receipt

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This affidavit of loss was sworn by [name redacted] who lost an official receipt issued by [organization redacted] with receipt number [number redacted] for [name redacted]. The affidavit states that the receipt was accidentally left in an envelope in a tricycle in downtown [location redacted]. Despite efforts to retrieve it, the receipt could not be found and is considered lost. The affiant declares the information in the affidavit is true to the best of their knowledge.

Copyright:

© All Rights Reserved
Download as DOC, PDF, TXT or read online from Scribd
Download as doc, pdf, or txt
132 views1 page

Affidavit of Loss Receipt

Uploaded by

Junnel Cañete
This affidavit of loss was sworn by [name redacted] who lost an official receipt issued by [organization redacted] with receipt number [number redacted] for [name redacted]. The affidavit states that the receipt was accidentally left in an envelope in a tricycle in downtown [location redacted]. Despite efforts to retrieve it, the receipt could not be found and is considered lost. The affiant declares the information in the affidavit is true to the best of their knowledge.

Copyright:

© All Rights Reserved
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Republic of the Philippines )

_____________ ) SS.
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, do hereby depose and state:

1. That I am a holder of an OFFICIAL RECEIPT (OR) issued by


_____________________________ with the following particulars:

Receipt No. : __________


Name of Payor : _______________
Address : __________________
__________________

2. That unfortunately last __________________, I accidentally left


the brown envelope containing the said receipts in the tricycle I
rode at the downtown area and had attempted to recover the said
OR receipts;

3. That despite diligent efforts to retrieve the same, all my efforts


proved to no avail and considered it now deemed lost so that I have
executed this affidavit to confirm its loss;

4. That I attest to the truth and veracity of my afore-mentioned


declarations to the best of my knowledge.

IN WITNESS WHEREOF I have hereunto set my hand this


__________________, at Tacloban City, Philippines.

___________________
Affiant
_________________

SUBSCRIBED AND SWORN to before me this _____________________,


at __________________.

Doc. No. _____


Page No. _____
Book No._____
Series of 202__.

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