That the undersigned was issued philippine passport no. More than just a template, our stepbystep interview process makes it easy to create an affidavit of lost note. A written statement declaring the physical loss of a security usually through theft or destruction by fireflood. I have lost, misplaced, or did not receive the receipt documenting payment. Subscribed and sworn to before me on the date and at the place indicated below. Before me, a notar y public on the day personally appear ed. Fda affidavits, request for shipping records, receipt for samples and photographs technical bulletin o03 spa periodically receives questions about food and drug administration fda procedures during the course of establishment inspections and investigations, including affidavits, requests for shipping records, receipt for samples and photographs. Aos fee payment receipt details the following details the payment status of the aos fee for the immigrant visa case of smita dipesh jadav, case number bmb2009535104. General affidavit 7 documents affidavit of support 5 documents id theft affidavit 3 documents affidavit of birth 4 documents affidavit of marriage 4 documents job offer letter sample 3 documents letter template 1085 documents authorization letter sample 3 documents resignation letter template 7 documents letter of introduction. You can then open the word document to modify it and reuse it however you wish. I have lost or misplaced the vendor receipt, receipt was inadequate. I made diligent search to recover the said identification card but proved. I certify that this is a proper charge for a cost incurred while on official university business and that i have not previously requested, nor will i again request, reimbursement for this expense. I certify that this is a proper charge for a cost incurred while on official university business and that i have not previously requested, nor.
I am executing this affidavit to attest to the truth of the foregoing, to support my application for a new copy of the plan to be issued, and for whatever other official and lawful purposes it may serve. While on official university business i incurred the expense described above. An affidavit of loss is usually required when requesting for a replacement of a lost document or item. Affidavit of loss the official website of the philippine. The affidavit includes information such as the holders name and the circumstances surrounding the loss. Fill, sign and download affidavit of loss online on. I understand that repeated occurrences of lost receipts constitutes misuse of the procurement card and are subject to violations and loss of procurement. Affidavit of loss official receipt or for bail bond. Public attorneys are government lawyers that get paid from the peoples taxes.
An affidavit of loss is a written statement that describes the facts concerning the loss of an object, usually a document such as an identification card, a drivers license, passport, or documents relating to the registration of vehicles. The affidavit contains all details regarding the loss, the. One files an affidavit of loss when the certificate of the security is stolen or destroyed in a flood or fire. I certify that this is an accurate and proper charge for costs incurred while on official williams college business and that i have not previously requested nor will i again request reimbursement for these expenses from any other. This affidavit of lost document is an affidavit prepared to notify the court or another authority about the loss of an original document in order to obtain a ce. The document is written according to your responses clauses are added or removed, paragraphs are customised, words are changed, etc at the end, you will immediately receive the document in word and pdf formats. The filing of a false affidavit is a class a misdemeanor punishable by a. Affidavit of nonreceipt north dakota department of transportation, motor vehicle sfn 16782 72017 motor vehicle division nd dept of transportation 608 e boulevard ave. A financial affidavit is a sworn statement of an individuals income, expenses, assets, and liabilities and is often needed in divorce cases, legal separation, or other types of custody matters. Procurement card lost receiptinvoice affidavit please retain this form with the relevant jp morgan chase procurement card statement in case of an audit. That i am the sole proprietor of unicorn diving services, hostel and restaurant located at poblacion, dauin, negros oriental. Affidavit of loss at pao cebu i think most of us do not know about this that you can actually get a free notarization of your affidavit of loss from a public attorney.
Affidavit of loss template, sample form to fill out. Affidavit of loss in word and pdf formats toggle navigation. Affidavit for lost receipt fayette county public schools. I also reported the loss of the said philippine passport to the philippine embassy in beijing as was accordingly issued a replacement passport no. The owner shall report the nonreceipt or loss of the license plate or decal to the appropriate law enforcement agency or official, including, but not limited to, a municipal or county police department of officer, the county sheriff, or. I am executing this affidavit to attest to the truth of the foregoing statements and to request the issuance of a new insert name of itemdocumentpaper in lieu of the one which was lost. Sample joint affidavit of two disinterested persons for delayed birth registration. An affidavit of loss form is a legally written statement that declares a lost item. Missing receipt affidavit a missing receipt affidavit should only be used if you did not obtain a receipt from the merchant and have exhausted all methods of obtaining a copy of the receipt, including contacting the vendor and requesting an emailedscannedfaxed copy.
Affidavit for lost or no receipt fairview health services. Lost receiptinvoice affidavit cardholder name please print. Loss of the receipt has been reported to the procurement card administrator and this signed document will be attached to the statement of account as a substitute for the original receipt. Baltazar, filipino, of legal age, married, and with office address at 7f pacific star bldg. Print manager name attach this form to the employee business expense report or ooppcard statement, as applicable. I make this affidavit of declaration of loss of the check described herein for the purpose of requesting a replacement check be issued. The missing receipt affidavit should be used when the merchant has not provided a receipt or a duplicate receipt.
Affiant signature over printed name competent evidence of identity id. Affidavit of loss passport philippines free legal forms. Free affidavit of lost document free to print, save. An affidavit of loss is a legal document containing a written statement declaring a physical loss of a necessary document. Affidavit for loss of original receipt of sdcd to be furnished on rs. Affidavit of loss financial definition of affidavit of loss. Common price if you have your printed document is 100 php while they charge 150 php if they will create it from scratch for you well, not really from scratch since they already have a template for that. Suppliermerchant did not provide a detailed receipt. The good news is once you officially file for a new document, you can usually get it reasonably. Citizenship affidavit form affidavit of financial support form bank affidavit small estate affidavit affidavit of common law marriage paternity affidavit form affidavit of gift form affidavit of nonprosecution form affidavit of. You can create your own affidavit of loss and have it notarized to any notary public. Hereunder are the facts and circumstances surrounding the loss of my identification card. I execute this affidavit to attest to the truth of the foregoing. One must file an affidavit of loss in order to receive a bond of indemnity and replace the lost security.
In witness whereof, i have hereunto signed these presents on. Purchasing card pcard fuel card i certify that i made the purchase shown below for official business but do not have a receipt because check all that apply. I am submitting this affidavit in lieu of the missing receipt. While conducting official state of washington business i incurred the expense described above. Affidavit of nonreceipt of an original license plate. Affidavit of loss form, printable affidavit of loss form. This affidavit and attached descriptive statement are made voluntarily. The physical loss of items due to theft or destruction by a natural calamity like fire or flood can be reported through this affidavit form. The statements written in the affidavit should be authentic. Signed on the date and at the place indicated below. Affidavit of loss template making a legal declaration.
The undersigned agrees to indemnify the bank for any expense, damage, or loss it may incur for acting pursuant to the instructions herein of the undersigned customer. An affidavit of loss is typically used when an important record or document is misplaced, stolen, destroyed or mutilated it may be a stock certificate, vehicle title or registration, promissory note, passport or visa, cheque payment etc. Many financial institutions or government agencies will have a prescribed form which must be completed. I am executing this affidavit for the information of all the authorities concerned. As such, i am executing this affidavit of loss to attest to the truth of the foregoing and to support the application for the issuance of new one in lieu of the one which was lost. I certify that this is a proper charge for a cost incurred while on official university business and that i. That i am the billing and collection department head of hacienda macalauan, inc. The example below is an affidavit of loss of a vehicle certificate of registration, you can change this form to a loss of drivers license or of any other item by changing the data. Whether the document is misplaced, stolen, or destroyed, the person must file an affidavit of loss to confirm that the document is not physically present anymore. That i am a registered owner of smart retailer sim bearing no. A copy of your debit or credit card statement must accompany this lost receipt affidavit.