REPUBLIC OF THE PHILIPPINES )

Municipality of Bangued ) S.S.

Province of Abra )

AFFIDAVIT OF LOSS

I, KATHLENE JANE B. BOSE, 21 years of age, Filipino, single and a

resident of Bacsil, Angad, Abra, after having been duly sworn to in
accordance with law, hereby depose and state THAT:

1. I am a 3rd year college student of Abra State Institute of Sciences

and Technology taking up Bachelor of Industrial Technology;
2. I was issued a School ID with No. 150875, which I always wear in
going to and from the school;
3. Last March 29, 2018, I have found out upon reaching home that
the above-mentioned school ID was lost;
4. It is my belief that the said ID was lost while I was riding a tricycle
on my way home from school;
5. I exerted earnest efforts to trace the said ID in my things but to
no avail I did not find the same, and is now considered lost
beyond recovery;
6. I am executing this affidavit to attest to the veracity of the
foregoing statements, to support my application for a new School
ID and for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

4th day of April 2018 at Bangued, Abra, Philippines.

KATHLENE JANE B. BOSE

Affiant

SUBSCRIBED AND SWORN TO before me this 4th day of April

2018 at Bangued, Abra, Philippines.

Public Attorney I
PAO - Bangued, Abra
Pursuant to R.A. 9406