Professional Documents
Culture Documents
Affidavit of Loss
Affidavit of Loss
Affidavit of Loss
2. That I am executing this affidavit to attest to the truth of the foregoing facts and to
support the Re-Execution of Lease Contracts.
____________________________ at _______________________________________
(Date) (Place of execution)
____Dennis Ty____
Affiant
Notary Public
REPUBLIC OF THE PHILIPPINES )
City/Municipality of ____________ )
___________________________ ) S.S.
Province of __________________ )
1. That I am a bonafide member of the Social Security System with SSS number
_______________________
1. That I was separated from my last employer, _____________
2. ____________________, with address at ________________
3. ____________________ on _______________ thereafter,
4. I was never again re-employed.
2. That I cannot secure a certification of separation
5. from my last employer because ________________________
3. That I am executing this affidavit to attest to the
6. truth of the foregoing facts and to support my
________________________________________________.
FURTHER AFFIANT SAYETH NAUGHT.
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _____________ day of
_____ 20___ in Quezon City, Philippines, affiant having
exhibited to me his/her Residence Certificate No. ___________________
_______________ issued in _________________________ on ________
20_________.
Notary Public
Until December 31, 20 ___
PTR No. _____________
Issued at _____________
DOC NO. ____________ Issued on _____________
PAGE NO. ____________
BOOK NO. ____________
SERIES OF ____________