Affidavit of Loss Template Philippines — Sample & Guide

What Is an Affidavit of Loss?

An Affidavit of Loss is a sworn declaration that a person has lost a specific item and attests to the circumstances of that loss. It is required by banks, government agencies, land registration authorities, and private institutions as a prerequisite for processing a replacement of the lost item.

In Filipino, this kind of sworn document is called a Sinumpaang Salaysay — for a lost item, a Sinumpaang Salaysay ng Pagkawala. Whether drafted in English or Filipino, the notarized affidavit carries the same legal effect.

Because the affiant swears to the truth of the statements before a notary public, the document carries legal weight — providing evidence that the loss occurred and protecting the institution from liability if the original item resurfaces.

When Do Filipinos Need an Affidavit of Loss?

Common situations where an Affidavit of Loss is required in the Philippines:

Lost bank passbook or ATM card — banks require this before issuing a replacement
Lost government-issued IDs — SSS, PhilHealth, Pag-IBIG, UMID, TIN, driver's license
Lost land title (TCT/CCT) — Register of Deeds requires it for owner's duplicate replacement
Lost vehicle OR or CR — LTO requires it for renewal or replacement
Lost PRC ID or license — PRC requires it for professional license replacement
Lost company or school ID — institutions require it before issuing a replacement
Lost checkbook or personal check — banks require stop-payment documentation plus an affidavit

Required Facts in an Affidavit of Loss

A proper Philippine Affidavit of Loss must state the following facts clearly:

Affiant's identity — full name, age, civil status, citizenship, address
Specific description of the lost item — include account numbers, ID numbers, plate numbers, or other identifying details
Date and place of loss — approximate date when the loss was discovered and last known location
Circumstances of loss — how the item was lost (misplaced, theft, fire, flood)
Search efforts — state that the affiant diligently searched but could not find the item
Purpose — state why the affidavit is being executed (e.g., "to support a request for replacement")
Undertaking — that if found, the affiant will surrender or return the original

Free Affidavit of Loss Template

Republic of the Philippines

City/Municipality of ) S.S.

Province of

AFFIDAVIT OF LOSS

I, [FULL NAME], [age] years old, [civil status], Filipino, with residence at [complete address], after being duly sworn in accordance with law, hereby depose and state that:

1. I am the lawful owner/holder of [describe item: e.g., "BDO Savings Passbook, Account No. "].

2. On or about [date], I discovered that the said [item] was missing from [last known location: e.g., "my residence at the above address"]. I last used/saw it on or about [date].

3. Upon discovery of the loss, I immediately and diligently searched for the same but all my efforts to locate it proved futile.

4. The loss was due to [circumstances: e.g., "the misplacement of the same during my relocation to a new residence" / "an unknown theft that occurred on "].

5. I am executing this Affidavit of Loss to attest to the truth of the foregoing and to request the issuance of a replacement for the lost [item].

6. Should the original [item] be found, I undertake to surrender or return it to the proper party/institution.

IN WITNESS WHEREOF, I have hereunto set my hand this day of , 20 at , Philippines.

[FULL NAME]

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this day of , 20, in , Philippines. Affiant exhibited to me his/her Competent Evidence of Identity: .

NOTARY PUBLIC

Until Dec. 31, 20
PTR No.
IBP No.
Roll No.
MCLE Compliance No.

Doc. No. ;

Page No. ;

Book No. ;

Series of 20.

Generate This Document Online — Free

Fill in the guided fields in Legalia and get a properly formatted Philippine document with the correct jurat block — ready to bring to your notary.

Generate Free

Step-by-Step: How to Fill Out an Affidavit of Loss

Prefer a visual walkthrough? See the step-by-step Legalia tutorial to generate a ready-to-notarize document in under 3 minutes.

Identify the lost item precisely. Include account numbers, serial numbers, plate numbers, or any unique identifier. Vague descriptions ("I lost my ID") are insufficient.
State the date and last known location. Approximate dates are acceptable. "On or about August 2025" is fine if you are unsure of the exact date.
Describe the circumstances honestly. Was it misplaced? Stolen? Destroyed in a flood? State the facts as you know them — do not invent circumstances.
State your search efforts. The institution wants to know you didn't simply misfile the document and will not later claim the replacement was duplicated fraudulently.
Include an undertaking. Many institutions require you to commit to surrendering the original if found — include this clause.
Have it notarized. Bring a government-issued ID with your photo and signature to the notary public. The notary will administer the oath and affix the jurat.

Affidavit of Loss vs. Police Report

Some institutions — particularly banks for lost ATM cards or government offices for lost IDs — require a police blotter entry in addition to the Affidavit of Loss, especially for items likely stolen. Check with the specific institution whether both documents are required. The affidavit and the police blotter serve different purposes: the affidavit is a sworn statement of facts; the blotter is the record of a reported incident.

Frequently Asked Questions

What is an Affidavit of Loss in the Philippines?

An Affidavit of Loss is a sworn statement attesting that the affiant lost a specific item — such as an ID, passbook, land title, OR, or company ID — and describes the circumstances of the loss. It is required before banks, government agencies, and private institutions will process a replacement.

What documents can I use an Affidavit of Loss for?

Common uses include: lost bank passbooks, lost ATM/credit cards, lost government IDs (SSS, PhilHealth, TIN, UMID), lost land title (TCT/CCT), lost vehicle OR/CR, lost company ID, lost passport, and lost personal checks. Each institution may have specific requirements alongside the affidavit.

Does an Affidavit of Loss need to be notarized?

Yes. An unnotarized affidavit is merely a private document. Almost all institutions require it to be notarized before they will process any replacement or request.

What are the required facts in an Affidavit of Loss?

The affidavit must state: (1) the affiant's identity and address; (2) the specific item lost with identifying details (e.g., account number, ID number, plate number); (3) the date, time, and circumstances of loss; (4) that the affiant searched but could not find the item; and (5) the purpose for executing the affidavit.

Is there a penalty for filing a false Affidavit of Loss?

Yes. Executing a false affidavit is perjury under Article 183 of the Revised Penal Code, punishable by imprisonment and a fine. Only execute an Affidavit of Loss if the item is genuinely lost or destroyed.

What is an Affidavit of Loss called in Filipino?

In Filipino, a sworn statement is called a Sinumpaang Salaysay, so an Affidavit of Loss is often referred to as a Sinumpaang Salaysay ng Pagkawala. An affidavit executed in English serves exactly the same purpose. Banks, government agencies, and notaries accept either version, as long as it is subscribed and sworn before a notary public.

Affidavit of Loss Template Philippines: Sample & Complete Guide