AFFIDAVIT OF LOSS

I, Jose Burgos Filipino citizen, of legal age, single and residing at Blk. 27 Lt.
3 Polomoc, Barangay Sampaloc, Alabang Muntinlupa City , after being duly sworn
according to law, hereby depose and state that:

1. That I am a holder of San Beda College Identification Card No.

2013500189 issued by San Beda College on June 10, 2011.
2. That sometime in 10th of December 2013, I lost the abovementioned I.D.
under the following circumstances:
a. In the evening of 10th of December 2013, I was walking beside
Alabang-Zapote road waiting for a jeepney to ride, when a man
went in front of me, who pointed a gun in my face, announced a
hold-up. He said he just wanted by bag and compelled me to give it
to him; otherwise he will pull the trigger and kill me. So, while me
begging him not to do it and frightened by the gun, gave him
immediately my bag. After obtaining my bag, he just simply ran
away and vanished.
b. Inside my bag is, among others, my I.D.
3. Despite diligent effort and hoping that the robber left my bag somewhere
near the area, I could no longer locate it and it was truly lost;
4. That I am executing this affidavit to certify the loss of the above-
mentioned I.D. for the purposes of securing its replacement and to attend
my class until the replacement be issued.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th of December

2013 in the City of Muntinlupa , Philippines.

Jose Burgos
Affiant

SUBSCRIBED AND SWORN to before me this 11 th of Decembe , affiant

exhibited to me
his/her Competent Evidence of Identity by way of Drivers License issued
at Sabang, Dasmarias City, Cavite, Philippines on 29 th of April 2010 .

NOTARY PUBLIC