Republic of the Philippines)

Olongapo City .) S.S.

AFFIDAVIT OF LOSS
I, NEIL CHRISTIAN L. JOSAFAT, of legal age, single, Filipino, and presently
residing at 0105 Sison Street, Ilwas, Subic, Zambales, Philippines, after having duly
sworn to in accordance with law, hereby depose and state:
1.

That I am an student of LYCEUM Subic Bay, located at Subic bay Freeport

Zone, Philippines;

2.

That sometime last October 2014, after our semestral school break, I
inspected my personal school documents and then and there, I found out
that my SBMA Student ID Pass was already missing;

3.

That despite diligent effort to locate the same, all efforts proved fruitless as
up to the present and fear that the same has been lost somewhere and
beyond recovery; and

4.

That I am executing this affidavit of loss to attest to the truth of the

foregoing, to request for re-issuance of my lost SBMA Student ID Pass
and for whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto affix my signature this 11th day of
November 2014 at Subic Bay Freeport Zone, Olongapo City, Philippines.

NEIL CHRISTIAN L. JOSAFAT

-Affiant SUBSCRIBED AND SWORN to before me this 11th day of November 2014 at
Subic Bay Freeport Zone. Affiant exhibited to me her Student ID Card No.
2013010114 as proof of his personal identification.

Doc No.: 278;

Page No. 57;
Book No.
5;
Series of 2014.