Friday, August 2, 2019

Affidavit of Loss


Republic of the Philippines)                                       
______________________      ) Sc.

AFFIDAVIT OF LOSS 


 I,      ______________________, Filipino, of legal age, married, and with residence and postal address at ________________________________________________________________, after having been duly sworn to in accordance with law, hereby depose and state that:

1.         I have been trying to look for the original Certificate of Registration of my car with the following details:
MAKE                    :  
MOTOR NO.                      : 
SERIES                  :  
SERIAL/CHASSIS NO.      : 
TYPE OF BODY      : 
PLATE NO.                        : 
YEAR MODEL        : 
FILE NO.                           : 

C.R. NO.                            :  


2.         Diligent efforts to locate the said document were exerted but it proved futile; and

3.         I am executing this affidavit to attest to the truthfulness of the foregoing facts and for the purposes of declaring it loss and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ____________________ at __________________, Philippines.

AFFIANT FURTHER SAYETH NAUGHT.
                                                
______________
               Affiant                       
                                                
JURAT

SUBSCRIBED AND SWORN to before me this _____ day of ____________________________ affiant personally appeared and exhibited to me his Government-issued Identification Card No. ________________________, issued on _____________________ at City of Makati.

NOTARY PUBLIC

Doc.  No.: _____;
Page No.: _____;
Book No.: _____;
Series of 2019.



Tuesday, May 21, 2019

AFFIDAVIT OF ECONOMIC STATUS SAMPLE


Republic of the Philippines )
City of ___                         ) Sc.


AFFIDAVIT OF ECONOMIC STATUS

I, AAA, of legal age, Filipino citizen and with residence address at 143 Brgy IloveYou, Manila, after having been sworn to in accordance with law, do hereby depose and state, that:


1.     I am applying for Violet Card at XXX Medical Center, Manila, to support my medication and in connection therewith, I am required to submit a sworn statement of my economic status, hence this affidavit;

2.     I am solo parent with one minor child still studying;

3.     I am not getting any financial support from the father of my minor child;

4.     I am unemployed and our sole source of income is my sari-sari store located in our residence at 143 Brgy IloveYou, Manila;

5.     I am earning Two Hundred Pesos (P200.00) daily income from my sari-sari-store, of which we are getting our daily expenses, and payment for utility bills and rental fee;

6.     I am executing this affidavit to attest to the truth of the foregoing facts and for purposes of applying for issuance of Violet Card issued by XXX  Medical Center.

AND FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby signed this Affidavit on this ____day of ______________20__ in the City of ________________ on ______________.


AAA
Affiant
Signed in the Presence of:

______________________________                  _____________________________

REPUBLIC OF THE PHILIPPINES )
CITY OF _______________________) Sc.

JURAT

SUBSCRIBED AND SWORN to before me this___________________________ in the City of _____________, affiant exhibiting to me his/her government issued identification card No. __________________________________, issued on _________________, issued at ______________.  

NOTARY PUBLIC
Doc. No. :_______
Book No. :_______
Page No. :_______
Series of :2019.