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The legal forms on this website are for general use and may vary based on legal requirements. Users are responsible for ensuring accuracy and completeness. Filling out a form does not create an attorney-client relationship. For a personalized legal advice, consult a lawyer. All items enclosed in [brackets] are required to be filled out.
REPUBLIC OF THE PHILIPPINES
[Province/City/Municipality]) S.S.
AFFIDAVIT OF MUTILATION
I, [Full Name], of legal age, [civil status], [nationality], and presently residing at [Complete Address], after having been duly sworn to in accordance with law, depose and state:
That I am the owner/holder of [describe the mutilated document/item, e.g., passport, ID card, ATM card, official receipt, certificate, etc.], with the following details:
Type of Document: [e.g., Passport, PRC ID, Driver’s License, etc.]
Document/ID No.: [Identification or Serial Number]
Issuing Authority: [e.g., Department of Foreign Affairs, Land Transportation Office, etc.]
Date of Issue: [Date]
That the said document/item has been mutilated/damaged due to [state the reason, e.g., accidental tearing, water damage, fire, exposure to chemicals, etc.], rendering it unusable/unreadable/partially destroyed;
That the mutilation occurred on or about [date of incident], at [place where it happened], and despite my efforts to preserve it, the document/item is no longer in a condition suitable for use;
That I am executing this affidavit to attest to the mutilation of the said document/item and to request for its replacement from the appropriate issuing authority, or for whatever legal purpose it may serve; and
That I attest to the truthfulness of the foregoing statements and am willing to submit this affidavit along with any other necessary supporting documents
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of [month], [year], at [place of execution].
[Full Name]
Affiant
SUBSCRIBED AND SWORN TO before me in the City/Municipality of [location], this ___ day of [month], [year], by affiant who has satisfactorily proven his/her identity through [Government ID type and number], issued on [date] and expiring on [date], that he/she is the same person who personally signed before me the foregoing Affidavit of Loss and acknowledged that he/she executed the same.
NOTARY PUBLIC
Doc No. ____;
Page No.____;
Book No. ___;
Series of [YEAR].
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