Republic of the Philippines)

City of Pagadian)
x-----------------------x

AFFIDAVIT OF LOSS

I, LORD JOHN S. LANZADO, of legal age, single and a resident of Purok San
Francisco Nazareth Barangay Buenavesta., Pagadian City, Zamboanga Del Sur, after
being duly sworn in accordance with law, deposes and states: THAT-

1. I am a Zamboanga Del Sur Maritime Institute of Technology (ZSMIT) student

located at Pagadian City, Zamboanga Del Sur;

2. As such, a School Identification Card with I.D No. 1511951 was issued in my name
by Zamboanga Del Sur Maritime Institute of Technology;

3. Sometime in June 16,2017, in the morning when I was on my way home riding a
tricycle from school I can still remember that I placed the said Identification Card
(ID) inside my bag;

4. When I arrived at our house said Identification Card (ID) was no longer inside my
bag which I placed earlier;

5. I then immediately trace back my route in search for my missing ID but to no

avail;

6. As all efforts to find the same proved unrewarding, it is now safe to conclude that
recovery of the said Identification Card (ID) is an impossibility;

7. Thus, I execute this affidavit to establish its loss and to support my application for
the issuance of a new Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand 19th day of June 2017 at
Pagadian City, Philippines.

LORD JOHN S. LANZADO

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of June 2017 in Pagadian
City, Philippines.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2017.