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Affidavit of Loss for Wallet in Roxas City

Angelie Regie J. Estorque files an affidavit of loss after misplacing her shoulder bag containing her wallet while driving home from Roxas City, Philippines on November 11, 2021. Her wallet held her school ID, driver's license, RF card, and 500 Philippine pesos in cash. Despite returning to search for her bag, she was unable to find it. She executes this affidavit under penalty of perjury to attest to the truth of her statements.

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16 views2 pages

Affidavit of Loss for Wallet in Roxas City

Angelie Regie J. Estorque files an affidavit of loss after misplacing her shoulder bag containing her wallet while driving home from Roxas City, Philippines on November 11, 2021. Her wallet held her school ID, driver's license, RF card, and 500 Philippine pesos in cash. Despite returning to search for her bag, she was unable to find it. She executes this affidavit under penalty of perjury to attest to the truth of her statements.

Uploaded by

Angelie
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Republic of the Philippines)

Roxas City ) S. S.

x- - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT OF LOSS

I, ANGELIE REGIE J. ESTORQUE, of legal age, Filipino, and a resident of Brgy. Pob. Ilaya Dao, Capiz
Philippines, after being sworn in accordance with law, depose and say THAT:

On November 11, 2021, I was driving home from Roxas city. I put my wallet at the back of my pants
where there is a pocket.

It was then when, I have noticed my shoulder bag was missing, thus, I made hardly to retrieve said bag
by going back to the said city but failed to find it.

Further , the aforementioned wallet contained of my school I.D, Drivers License, RF and a money with
the amount of Five Hundred peso Bill (500).

I am executing this affidavit under pain of perjury to attest to the truth and veracity of the foregoing
statements and for all legal intents and purposes this affidavit may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________ in the City of Roxas, Capiz,
Philippines.

ANGELIE REGIE J. ESTORQUE

Affiant

ID: LICENSE F04-20_101162


SUBSCRIBED AND SWORN to before me this _____________________ in Roxas, City Capiz, the
affiant exhibiting his Identification Card written below his name as competent proof of identity.

Doc. No. _____

Page No. _____

Book No. _____

Series of 2021.

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