REPUBLIC OF THE PHILIPPINES )
________, ________ ) S.S.
REPUBLIC OF THE PHILIPPINES )
CITY OF ________, PROVINCE OF ________ ) S.S.
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF ________, PROVINCE OF ________ ) S.S.
REPUBLIC OF THE PHILIPPINES )
CITY OF ________ ) S.S.
AFFIDAVIT OF LOSS
I, ________, of legal age, Filipino, ________, and a resident of ________, after having been duly sworn to in accordance with law, do hereby depose and state THAT:
1. I am the registered owner and lawful holder of a School Identification Card (the “School ID”) bearing Student Number ________, issued by ________ located at ________;
1. I am the ________ of ________, a minor, who is the registered owner and lawful holder of a School Identification Card (the “School ID”) bearing Student Number ________, issued by ________ located at ________;
2. On or about ________, I discovered the loss of the said School ID under the following circumstances:
2. On or about ________, the loss of the said School ID was discovered under the following circumstances:
________;
Xxxxx xx xxxxxxx xxx xxxx xxxxxxxxx xx xxxxxx xxx xxxxxxxx xxxx xx xxxxx xxxxxxx xxx xxxxxx xxxx xxxxxxxxxx xx xxx xxxxxxx xxxxx xxxx xx xxxxxxxx xxx xxxxx xxxxx xx xxxxxxx xxx xxxx xxxxxxxxx xx xxxxxx xxx xxxxxxxx xxxx xx xxxxx xxxxxxx xxx xxxxxx xxxx xxxxxxxxxx xx xxx xxxxxxx xxxxx xxxx.
4. The loss of the said School ID was not due to any fraudulent intent or design on my part, and the same has not been pledged, assigned, surrendered, or otherwise disposed of by me to any person or entity;
4. The loss of the said School ID was not due to any fraudulent intent or design on my part or on the part of ________, and the same has not been pledged, assigned, surrendered, or otherwise disposed of by either of us to any person or entity;
5. I am executing this Affidavit to attest to the truth of the foregoing statements, to formally report the loss of the said School ID, and to support my application for the issuance of a replacement thereof;
Xxxxx xx xxxxxxx xxx xxxx xxxxxxxxx xx xxxxxx xxx xxxxxxxx xxxx xx xxxxx xxxxxxx xxx xxxxxx xxxx xxxxxxxxxx xx xxx xxxxxxx xxxxx xxxx xx xxxxxxxx xxx xxxxx xxxxx xx xxxxxxx xxx xxxx xxxxxxxxx xx xxxxxx xxx xxxxxxxx xxxx xx xxxxx xxxxxxx.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ________ day of ________, 20____, at ________, Philippines.
________
Affiant
________
Competent Evidence of Identity
SUBSCRIBED AND SWORN TO before me this ________ day of ________, 20____, at the City/Municipality of ________, Province of ________, by the affiant, ________, who is personally known to me or who exhibited to me the following competent evidence of identity: ________, and who I am satisfied is the person who personally signed the foregoing instrument and acknowledged before me that the same is his/her free and voluntary act and deed, executed in accordance with the 2004 Rules on Notarial Practice.
SUBSCRIBED AND SWORN TO before me this ________ day of ________, 20____, at the City/Municipality of ________, Province of ________, by the affiant, ________, who is personally known to me or who exhibited to me the following competent evidence of identity: ________, and who I am satisfied is the person who personally signed the foregoing instrument and acknowledged before me that the same is his free and voluntary act and deed, executed in accordance with the 2004 Rules on Notarial Practice.
SUBSCRIBED AND SWORN TO before me this ________ day of ________, 20____, at the City/Municipality of ________, Province of ________, by the affiant, ________, who is personally known to me or who exhibited to me the following competent evidence of identity: ________, and who I am satisfied is the person who personally signed the foregoing instrument and acknowledged before me that the same is her free and voluntary act and deed, executed in accordance with the 2004 Rules on Notarial Practice.
________
NOTARY PUBLIC
Doc. No.: ________;
Page No.: ________;
Book No.: ________;
Series of ________.
{"version": 1, "questions": [{"key": "venue_kind", "label": "Where is the affidavit sworn?", "type": "text", "choices": [{"value": "printed", "label": "Keep the printed venue line (city or municipality, province)"}, {"value": "city", "label": "In a city within a province"}, {"value": "municipality", "label": "In a municipality"}, {"value": "independent", "label": "In a highly urbanized or independent city - no province"}], "default": "printed"}, {"key": "affiant_role", "label": "Who signs the affidavit?", "type": "text", "choices": [{"value": "student", "label": "The student who holds the School ID (of legal age)"}, {"value": "parent", "label": "A parent or guardian of a minor student"}], "default": "student"}, {"key": "affiant_gender", "label": "Is the affiant (the person signing) male or female?", "type": "text", "choices": [{"value": "printed", "label": "Keep \"his/her\" in the notarial certificate"}, {"value": "male", "label": "Male - \"his\""}, {"value": "female", "label": "Female - \"her\""}], "default": "printed"}], "labels": {"student_relationship": "Your relationship to the student (father, mother or legal guardian)", "student_name": "Full name of the student"}, "help": {"affiant_role": "The affiant states that he or she is of legal age. If the student is a minor, a parent or guardian signs and the student's name is stated in paragraph 1."}, "constraints": [], "dateRanges": [], "legacyReviewKeys": [], "scope": "A sworn affidavit of loss (Philippines) for a lost School Identification Card, to report the loss, hold the school free and harmless and support the application for a replacement ID. The form adapts the venue, whether the student or a parent or guardian of a minor student signs, and the affiant's gender in the notarial certificate.", "notice": "A sworn affidavit of loss (Philippines) for a lost School Identification Card, to report the loss, hold the school free and harmless and support the application for a replacement ID. The form adapts the venue, whether the student or a parent or guardian of a minor student signs, and the affiant's gender in the notarial certificate."}