Affidavit of Loss - Lost of Construction Bond Receipt

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Republic of the Philippines)

_____________ City )S.S

AFFIDAVIT OF LOSS

I, ____________________, Filipino, of legal age, married, and a resident


of ______________________________, after having duly sworn to in accordance
with law, do hereby depose and state, THAT:

1. I am the owner of _______________________ (“______” for brevity);

2. An original receipt with no. ______, which was issued by _______________


in _______________, was in my possession. For reference purposes, attached to
this affidavit is the photocopy of said receipt;

3. Lately, I have discovered that I unknowingly dropped or misplaced the


aforesaid receipt;

4. When I noticed that said receipt is no longer in my possession, I immediately


looked for it, but despite the diligent search and efforts, I have failed to
locate the same up to the present. Hence, I now believe that the aforesaid
receipt is lost beyond recovery;

5. As such, I am executing this affidavit of loss considering the said original


receipt is needed to release the construction bond amounting to
_________________________ Pesos (Php _________). Additionally, I attest to
the truth of the foregoing facts.

IN WITNESS WHEREOF, I have set my hand this ____________________, in


the City of _______________, Philippines.

_____________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ____________________, in the City


of __________, Philippines, affiant, who exhibited his/her ________________
with number ____________________ as competent proof of identity.

Doc. No.
Page No.
Book No.
Series of 2022.

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