Affidavit of Loss: Meaning, Purpose, and Sample Form
An Affidavit of Loss is a sworn legal document used when an individual loses an important item, such as an identification card, ATM card, SIM card, certificate, receipt, permit, license, or any official document. This affidavit states the circumstances of the loss and is often required to request a replacement, block unauthorized use, or update official records.
Government agencies, banks, schools, telecom companies, and private institutions typically require this affidavit as part of their verification or document replacement process. It serves as formal proof that the item was lost and that it was not intentionally disposed of or handed to someone else.
Common Items Requiring an Affidavit of Loss
This affidavit is used for the loss of:
- Government IDs (PhilHealth, SSS, Pag-IBIG, PhilSys, Postal ID, Barangay ID)
- School ID or Company ID
- ATM Card, Debit Card, or Passbook
- SIM Card or Mobile Number
- Official Receipts and Acknowledgment Receipts
- Birth, Marriage, or Death Certificates
- Licenses, permits, and registration documents
- Any official document or card issued by an institution
Some institutions may require police reports, valid IDs, or supporting documents depending on the sensitivity of the lost item.
What Should Be Included in an Affidavit of Loss?
A complete Affidavit of Loss contains:
- Personal details of the affiant
- Description of the lost item
- Date, place, and circumstances of the loss
- Statement of good faith and non-recovery
- Purpose of the affidavit (e.g., replacement, deactivation, blocking)
- Signature of the affiant and notarization
For security-sensitive items (e.g., ATM, SIM), immediate reporting to the institution is also recommended.
Sample Affidavit of Loss (Editable Template)
Replace all bracketed text below before printing and notarizing. You may also specify multiple lost items if needed.
REPUBLIC OF THE PHILIPPINES
[CITY / MUNICIPALITY]
[PROVINCE]
AFFIDAVIT OF LOSS
I, [FULL NAME OF AFFIANT], of legal age, [citizenship], [civil status], and residing at [complete address], having been duly sworn in accordance with law, hereby state:
1. That I am the owner and lawful holder of the following item(s): [Name of ID / ATM / SIM / Certificate / Receipt / Document], issued by [Name of Agency or Company].
2. That on or about [date of loss], while at or near [place of loss], I discovered that the said item(s) was/were missing and could no longer be located despite diligent search and efforts to recover the same.
3. That the circumstances of the loss are as follows: [state how the item was lost—misplaced, stolen, left behind, dropped, unreturned, etc.].
4. That said item(s) has/have not been surrendered to me, recovered, or found as of the date of this affidavit, and that I am executing this Affidavit to report the loss and request for: [replacement / reactivation / deactivation / blocking / official record update].
5. That I undertake full responsibility for any misuse of the lost item(s) prior to the blocking or replacement by the issuing institution.
IN WITNESS WHEREOF, I have hereunto affixed my signature this [day] day of [month, year], at [place of execution].
_________________________________
[FULL NAME OF AFFIANT]
Affiant
SUBSCRIBED AND SWORN to before me this [day] of [month, year] at [place], affiant presented the following proof of identity:
ID Type and Number: [ID Number]
Date & Place of Issuance: [details]
_________________________________
NOTARY PUBLIC
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of _____.
Disclaimer: Some institutions may require additional documents such as police reports, deactivation forms, or affidavits from witnesses depending on the sensitivity of the lost item.