Affidavit of Loss Official Receipt or for Bail Bond

Affidavit of Loss Official Receipt OR for Bail Bond) REPUBLIC OF THE PHILIPPINES) Province of ____________________) S.S. City/Municipality of _____________) x-----------------------x

AFFIDAVIT OF LOSS

I,

_____________,

Filipino,

of

legal

age,

and

a

resident

of

_____________, Philippines, after being duly sworn in accordance with law, depose and state: That I am defendant in Criminal Case No. _____________ before the _____________ Trial Court, Branch ______, _____________ City, which

is

for

_____________;

That on _____________ and to secure my provisional liberty in the said criminal case, I posted a Cash Bail Bond in the amount of _____________ (P_____________) and was issued Official Receipt No. _____________; As the aforementioned criminal case against me was already dismissed, I looked for the original copy of the said Official Receipt No. _____________ to get back my cash bail bond;

However, despite diligent search and efforts to locate the said original copy of the said Official Receipt No. _____________, the same could not be found and must have been misplaced and

irretrievably lost, such that I now believe that it is now lost beyond recovery; As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and in support for my request for the release of my P_____________ cash bail bond and for whatever legal purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.

AFFIANT

(JURAT)