How to Make an Affidavit of Loss (Free Sample and Template)

Learn how to write an affidavit of loss to declare the loss of your belongings

Losing your precious belongings can be a harrowing experience, especially if these are legally or financially important documents such as government-issued IDs and ATM cards. Fortunately, you can request a replacement for your lost items by executing an affidavit of loss and submitting it to the office or institution concerned.

An affidavit of loss is a sworn statement made under oath declaring the loss of an item or property, usually with the expressed intention to request a replacement of the lost item. In the affidavit, the owner (or affiant) states that the item or property is lost beyond recovery and can no longer be found despite his best efforts to locate it. The loss may be due to theft, neglect, misplacement, destruction due to disasters such as flood or fire, and other circumstances.

An affidavit of loss is often required if the owner wants to apply for a new item as replacement for the lost one. For example, if the owner or affiant lost his UMID card, he can submit an affidavit of loss to the Social Security System (SSS) describing the circumstances surrounding the loss in order to be given a replacement ID card.

Since the affidavit of loss is a sworn statement, knowingly providing any false or misleading information is an act of perjury under Article 183 of the Revised Penal Code and other applicable laws. Therefore, it’s important to be completely truthful in your statement and to avoid giving false, inaccurate or deceptive information in your affidavit.

You can have your affidavit of loss drafted and signed a notary public for a minimal fee, but if you want to create your own affidavit, we have provided instructions and steps on how to do it. We have also included a sample affidavit that you can freely modify with your own information. Take note, however, that you still need to have your affidavit notarized for it to become a valid and legal document.

Disclaimer: This article is for educational purposes only and does not constitute legal advice. If you require specific legal advice, please contact a lawyer.

Table of Contents

How to Write an Affidavit of Loss

Writing your own affidavit of loss is perfectly acceptable as long as you follow a basic format. Before you create the affidavit, make sure that you have the following information:

You may follow this format in writing your affidavit:

  1. On the upper-left portion of the document, indicate the venue which is the place where the notarization occurs. This should be the name of the country (e.g. “Republic of the Philippines”), followed by the city or municipality (e.g. “City of Manila”). At the end of each line is a closing parenthesis. The abbreviation “s.s.” (Latin term scilicet which means “namely”) is also included after the city or municipality.
  2. Write the heading “AFFIDAVIT OF LOSS” in capital letters and center it in the document.
  3. Write the introductory paragraph stating your complete name, nationality and residence. Also indicate that you are of legal age and that you are testifying under oath (e.g. “depose and state”).
  4. State that you are the holder or owner of the lost item or property. Below this statement, indicate the name or description of the item.
  5. Declare that the item was inadvertently lost or misplaced from possession. If the item or property was stolen or destroyed due to fire, flood, etc., explain in detail how the item was lost (e.g. “My wallet containing the ID was stolen while I was riding a jeepney”).
  6. Mention that you have exhausted all efforts to locate the lost item, but you were not able to find it.
  7. Indicate your purpose for executing the affidavit (e.g. “To support the application for the issuance of a new ID”).
  8. Write the attestation clause beginning with “In witness whereof” and indicate the date and place of attestation.
  9. Write your complete name and affix your signature above it.
  10. Write the oath or affirmation statement beginning with “Subscribed and sworn before me” and indicate the date and place of execution of the affidavit.
  11. Indicate the name of the notary public if already known.

After creating your affidavit of loss, print three (3) copies on legal or A4 paper and bring them to the notary public for notarization. If you can’t find a notary public near you, you can visit the Public Attorney’s Office to have your affidavit notarized. Many city and municipal halls also have notaries public ready to notarize your document.

To make things easier and save time, you can use our sample affidavit as a starting point. Just copy or download our free template and modify it to suit your needs.

Sample Affidavit of Loss

Here’s a sample affidavit of loss that you can copy and paste to your Word or Google Docs document. Simply replace the words inside brackets [ ] with your own specific information.

Republic of the Philippines)
[City/Municipality] …… ) s.s.

AFFIDAVIT OF LOSS

I, [NAME OF AFFIANT] , of legal age, [Nationality] , and a resident of [Address of Affiant] , after having been duly sworn to in accordance with law, do hereby depose and state:

That I am the holder/owner of item below:

That the said [Name of item] was inadvertently lost and/or misplaced from my possession;

That despite of diligent search and efforts to locate the said [Name of item] , I could not find the same such that I now believe that it is now lost beyond recovery;

That I am executing this affidavit of loss to attest to the truth of the foregoing and to support the application for the issuance of a new one in lieu of the one which was lost and for whatever legal intent this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this _____ day of _____________ in [City/Municipality] , Philippines.

[Signature of Affiant]
[NAME OF AFFIANT]
Affiant

SUBSCRIBED AND SWORN before me this _____ day of _____________ in [City/Municipality] , Philippines.

[Signature of Notary Public]
[NAME OF NOTARY PUBLIC]
Notary Public

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

Affidavit of loss

Download a Sample Affidavit of Loss

Download a free affidavit of loss template for Microsoft Word by clicking “Download Word Document” below. Modify or edit the article in Word by replacing the information inside brackets [ ] with your own.

If you are using Google Docs, click “Open in Google Docs” and then make a copy of the document by clicking File > Make a Copy before editing the document.

How to Edit the Sample Affidavit of Loss

Follow these steps to modify or edit the sample affidavit in Microsoft Word format:

  1. Download the Microsoft Word document by clicking this link.
  2. Open the document in Microsoft Word (Ctrl + O).
  3. Click the “Enable Editing” button above the document when prompted.
  4. Replace the words inside the brackets [ ] with your own facts and information.
  5. Save the document by clicking File > Save or by typing Ctrl + S.
  6. Print the letter by clicking File > Print or by typing Ctrl + P. Make three (3) copies of the affidavit: one for the notary public, one for yourself, and one for the entity where you will submit the affidavit.
  7. Sign the letter and bring it to the notary public for notarization.

Frequently Asked Questions

Does the affidavit of loss have an expiration date?

An affidavit of loss doesn’t expire and is valid for life. However, the affidavit is meant only for a specific lost item, so if you acquired a replacement for the item and you also lost it, you will have to execute another affidavit.

Where can I have my affidavit of loss notarized?

You can have your affidavit signed, sealed and notarized by a notary public, who is a person legally authorized to administer oaths and to certify public documents.

I don’t know a notary public. Where can I find one?

If you don’t know any notary public, you can have your affidavit notarized at the Public Attorney’s Office or the Hall of Justice. You can also inquire at your city or municipal hall where some notaries public may have their offices.

How much does it cost to have my affidavit of loss notarized?

The cost of notarizing an affidavit starts at ₱100 and may be higher depending on the place and the notary public. It might cost more if you have the notary public create the document for you as opposed to making your own.

Where can I have my affidavit notarized for free?

If you are an indigent person, you can have your affidavit notarized for free at the Public Attorney’s Office.

Parting Words

An affidavit of loss is one of the most important legal documents that you will come across in adult life. Keep in mind that some offices and institutions, such as banks, have their own templates that you can use, so make sure to search for them online before using our free template.

We hope that you’ve found our guide on affidavit of loss useful. Don’t forget to have your affidavit duly signed and notarized by a notary public before presenting it to the appropriate agency or institution. If you have any legal question or concern, don’t hesitate to contact a lawyer.

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