Professional Documents
Culture Documents
AFFIDAVIT OF LOSS I, ESTER A. BALCITA, of legal age, Filipino, married, and resident of Santa Cruz, Laguna, after being duly sworn according to law, hereby depose and state that: 1. I am a holder of a GSIS Policy Contract with Numbers 51102402093 which was issued in 2005 by the Government Service Insurance System; 2. I could not remember where I placed the said Policy; 3. Despite diligent efforts exerted, I could no longer locate, find or recover the same, and to the best of my knowledge, the same is truly lost; 4. I have no reason to believe or suspect the said POLICY is in possession or control of any other person; 5. I am executing this Affidavit to attest to the truth of the foregoing statements. AFFIANT FURTHER SAYETH NAUGHT. IN WITNESS WHEREOF, I have hereunto ___________________ at _________________________. set my hand this
SUBSCRIBED AND SWORN to before me this ____________________, affiant exhibited to me his/her Competent Evidence of Identity by way of _________________.
Notary Public
Doc. No. _____. Page No. _____. Book No. _____. Series ________.