REPUBLIC OF THE PHILIPPINES) ____________________ CITY ) S.S
AFFIDAVIT OF LOSS OF FIREARM
I,
___________________
, of legal age, Filipino citizen, married, and with residence at No. 27 Durian Street, Project 2, Quezon City, after having been sworn to in accordance with law, do hereby depose and state that: 1.
I am the true and licensed owner of one (1) firearm, which is particularly described as: Make: Caliber: Kind: Serial No.: A copy of my Firearm License Card is hereto attached as
Annex “A”;
2.
That on _____(date)_____, I was inspecting my personal belongings and was surprised to find that the said firearm was missing from its case; 3.
That despite diligent search and efforts to locate the abovementioned firearm, I could no longer find the same, such that I now believe that it is lost beyond recovery; 4.
That I certify and confirm that the said firearm was neither confiscated nor relinquished in favor of, any government entity, agency, or authority; and 5.
That I am executing this Affidavit of Loss to attest to the truth of the foregoing and for whatever legal purpose it may serve.
IN WITNESS THEREOF
, I have hereunto set my hand this _____________ at ____________ City, Philippines.
______________________
Affiant
SUBSCRIBED AND SWORN TO
before me on this ___ day of ________ in ________________ City, affiant exhibiting to me his ________________ ID No. ____________ issued at _____________ on _______________. Doc No. ____;
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