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    Affidavit of Loss-Motas

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    Eric Jopson MA

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    Affidavit of Loss-Motas

    Uploaded by

    Eric Jopson MA
    12 views2 pages

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    Affidavit of Loss-motas

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    12 views2 pages

    Affidavit of Loss-Motas

    Uploaded by

    Eric Jopson MA

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Republic of the Philippines .

    )
    CITY OF TAGUM. . . . . . . ) S.S.
    Province of Davao del Norte)
    X - - - - - - - - - - - - - - - - - - - - - -X

    AFFIDAVIT OF LOSS

    I, BENEDICTO P. MOTAS, of legal age, Filipino, married, and a


    resident of Purok 3, #054 Betunlan St., Asuncion Poblacion, Davao del
    Norte, Philippines, after having been duly sworn to in accordance with law,
    hereby depose and say:

    1. That I am the same person whose personal circumstances are


    stated above;

    2. That I am the holder/owner of SSS Identification Card with


    bearing number 09-0539532-8, issued by Social Security
    System (SSS), Davao City;

    3. That sometime in January 2010, I discovered that the said SSS


    Identification Card was lost;

    4. That despite extra-diligent effort to locate the said SSS


    Identification Card, it can no longer be found;

    5. That I am executing this affidavit of loss attest to the truth of the


    foregoing facts and to inform the proper authority and for
    whatever legal purpose/s this may serve best.

    IN WITNESS WHEREOF, I have hereunto set my hand this


    ___________at Tagum City, Davao del Norte, Philippines.

    BENEDICTO P. MOTAS
    Affiant
    TIN: 901-240-540
    Issued by: BIR

    SUBSCRIBED AND SWORN to before me this _______________ at


    Tagum City, Davao del Norte, Philippines

    ATTY. MARIA LINA F. BAURA


    Notary Public
    Until December 31, 2011
    ROLL NO. 46881/PAGE NO. 377; BOOK NO. XIX
    PTR NO. 0884606/01-05-10/T.C.
    IBP NO. 778871/10-22-09/T.C.
    MCLE NO. III-0005250/10-12-09
    TIN NO. 178-128-212
    Doc No. ____;
    Page No. ___;
    Book No. ___;
    Series 2010.

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