REPUBLIC OF THE PHILIPPINES…)

ROXAS CITY, CAPIZ…………………....)S.S.

AFFIDAVIT

I, JUAN DELA CRUZ, Filipino Citizen, of legal age, single and with
postal address at Brgy. Malonoy, Dao, Capiz, after being duly sworn in
accordance with law, depose and state that:

1. That, I am currently enrolled as 2nd year college student

at St. Therese MTC-Colleges taking up Bachelors of
Science in Marine Transportation;

2. That, as such, I was issued a School Identification Card;

3. That, recently, I discovered that my school identification

card is no longer in my bag where I placed it;

4. That, in spite of diligent efforts to find the same, I

cannot anymore locate it up to the present and I believe
that it is already lost and beyond recovery;

5. That, I execute this affidavit to help support my request

for the re-issuance of a new school identification card;

6. That, I execute this affidavit to attest to the truthfulness

of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________________ at Roxas City, Capiz, Philippines.

JUAN DELA CRUZ

Affiant

SUBSCRIBED AND SWORN TO before me, a Notary Public

commissioned in and for the City of Roxas, Province of Capiz, Philippines, this
_____________________ by the affiant who is personally known to me and who
appeared and signed the foregoing AFFIDAVIT in my presence within my
jurisdiction, and who avowed to the truth of its contents under the penalty of
law.

Doc No.______;
Page No._____;
Book No._____;
Series of 2018.