Affidavit Of Loss

REPUBLIC OF THE PHILIPPINES ) CITY OF DIPOLOG ..) s.s.

AFFIDAVIT OF LOSS OF A SCHOOL ID

I, Juan de la Cruz, Filipino, of legal age, single and a resident of Dipolog City, under oath depose and say: That I am a bonafide student of Andres Bonifacio College, Dipolog City having enrolled thereat as a Third Year Law Student of the first semester of the School Year 2007-2008; That as such bonafide student, upon enrollment, I was issued school ID; That on or about August 1, 2009 while I was traveling on a motorcycle from my residence to the school, I accidentally dropped my wallet which contains among others the aforesaid school ID; That in spite of earnest effort to locate the same, it could no longer be found and the same is considered as lost; That I am executing this affidavit to state the truth about the loss of the said ID in connection with my desire to have another one issued in my name as required by my school. IN WITNESS WHEREOF, I hereunto affix my signature this 7th day of August 2010, in Dipolog City, Philippines.

JUAN DE LA CRUZ Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this 26th day of June 2010 in the City of Dipolog, affiant exhibiting his Community Tax Certificate No. 0123456 issued on January 4, 2010 at Estaka, Dipolog City.

JEAN J. CAETE- PANGO Notary Public

My commission expires on December 31, 2011 PTR No. 906760 issued Jan. 3, 2007 IBP No. 918300 Roll No. 13466

Doc. No. ____ Page No. ____ Book No. ____ Series of 2010