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Omnibus Affidavit of Loss
Omnibus Affidavit of Loss
AFFIDAVIT OF LOSS
I, ___, ___ years old, Filipino, married and a resident of ___, after
being duly sworn to in accordance with law, hereby depose and state:
a. ATM pension;
b. Driver’s License;
c. T.I.N Identification;
d. Social Security System I.D.;
e. Voter’s Identification;
f. Certificate of Registration and Official Receipt of my
Tricycle for 2018;
g. Municipal Keys;
h. Rural Bank Book;
i. PhilHealth Identification;
j. Seiko 5 Watch;
k. Samsung Galaxy Grandprime Cellular phone;
l. Cherry Mobile Cellular phone;
______________________
Affiant
NOTARY