Affidavit of loss sample

A sworn statement that a document or ID was lost and could not be found despite diligent search, which the SSS, PhilHealth, Pag-IBIG, the LTO, banks, schools and employers ask for before issuing a replacement. The format has the Republic of the Philippines and city "S.S." caption, your name and details, numbered paragraphs on what was lost, when, where and how, the purpose of the affidavit, and the notarial jurat with Doc. No., Page No., Book No. and Series. The sample is for a lost SSS UMID card; the AI swaps in your item in a sentence. It opens on Long bond, the size notaries and courts here expect.

Templates

  • Affidavit of loss (document): An affidavit of loss format for the Philippines with the Republic of the Philippines S.S. caption, the circumstances of the loss, the purpose and a notarial jurat. Sample affidavit for a lost SSS UMID card included.
  • Affidavit format (India) (document): A general affidavit format for India, on stamp paper, with deponent details, numbered statements, verification clause and notary attestation, for address proof, name change, lost documents, gap year or income. Sample affidavit for a name mismatch included.
  • General affidavit (US) (document): A general affidavit for the US: a sworn written statement of facts with the affiant's details, numbered statements, an oath under penalty of perjury and a notary jurat block. Sample affidavit of residence included.

How to use these templates

  1. Note the facts: what was lost, the number on it if you know it, roughly when and where it went missing, and what you did to find it.
  2. Open the template and tell the AI, for example "lost my company ID and BPI passbook while commuting from Cubao to Makati on 20 October, needed for replacement".
  3. Print it on Long bond paper, two copies or more, and do not sign yet.
  4. Sign in front of a notary public with a government ID, pay the notarial fee, and keep the notarized original; most offices accept a photocopy with the original shown.

Affidavit of loss tips

  • Sign only in front of the notary. An affidavit signed earlier is routinely refused, and the notary records your ID number and the date in the jurat.
  • Be specific but honest about the circumstances. "Lost on or about 20 October 2026, believed left in a jeepney along EDSA" is enough; do not invent details.
  • One affidavit per item is safer when different offices need it, since each keeps a copy. For several items lost together, one affidavit listing all of them is acceptable to most offices.
  • For an OR/CR or licence plate, the LTO wants the affidavit plus a police report; for a passport, the DFA wants a police report and the affidavit, and the lost passport is cancelled.
  • Notarial fees vary by city; a simple affidavit is usually a few hundred pesos. Bring one government ID and, if you have it, a copy of the lost item.

Frequently asked questions

Does an affidavit of loss have to be notarized?

Yes. Without the jurat it is only a letter. Government offices, banks and the LTO accept only a notarized affidavit.

Do I need a police report too?

For an SSS, PhilHealth or company ID, usually no. For a passport, a driver's licence, vehicle papers, firearms documents or a stolen item, the receiving office usually asks for a police blotter as well.

Why Long bond paper?

Notaries and courts in the Philippines use Long (8.5 x 13 inches) for affidavits and pleadings, and some notaries will not stamp a short-bond page. The template opens with Long selected; switch to Letter or A4 in the download menu if the office does not mind.

Can I sign it abroad?

Yes, before a notary where you are, then have it apostilled, or sign it at a Philippine embassy or consulate, which can notarize it directly.

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