Republic of the Philippines)
) S.S.
AFFIDAVIT OF LOSS
(Identification Cards)
I, ________, of legal age, Filipino, single and a resident of _________________, after having been duly sworn to in accordance with law, depose and state THAT:
1. I am a seafarer working overseas and was recently deployed in Hawaii.
2. Previously, I was issued the following documents/identification cards by the Philippine government:
a.) SSS ID No. ________
b.) Pag-ibig ID No. _________
c.) TIN ID No. _________
d.) OWWA Membership ID
3. During my latest deployment as fisherman-seafarer in Hawaii, I brought with me the said identification cards. I placed all of them in my wallet.
4. Unfortunately, on ________ around 4PM, our fishing vessel FV ______, while docked at ___________, got burned which started from the electrical components in the pilot house.
5. Luckily, I was not present during the said incident as I was in another boat having a haircut, but I left my wallet with all the above identification cards inside my locker which were all consumed by fire.
6. I tried to look for the said IDs after the fire was put out by a fire truck but the entire cabin area where my locker is located was burned; thus, these identification cards are now lost beyond recovery.
4. As such, I am executing this affidavit to attest to the foregoing facts and to support the application for the issuance of the new ones in lieu of those ones which were lost.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________________ in ___________, Metro Manila, Philippines.
_____________
Affiant
SUBSCRIBED AND SWORN to before me this _______ day of __________________ in __________________, Metro Manila, affiant exhibiting to her Government Issued ID No. __________ issued on _____________ at ____________.
NOTARY PUBLIC
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