REPUBLIC THE PHILIPPINES)

BATANGAS CITY ) S.S.

AFFIDAVIT OF LOSS

I, MARY ANN A. MAGADIA, single, of legal age, Filipino, and a resident

of Tinga Labac, Batangas City, after having been duly sworn to in accordance
with law, hereby, depose, and state that:

[1] I am a Senior High School student at Alangilan Senior High School

in Alangilan, Batangas City, hence, a holder of an Identification Card issued by
the said school;

[2] Recently, while I was searching for the said identification card, I
have discovered that the same was lost;

[3] I exerted diligent efforts to find and locate the said item but the
same proved futile;

[4] Moreover, said item has not been returned to me;

[5] I am executing this affidavit to attest to the truth of all the

foregoing facts, to inform the proper authorities and for whatever legal purpose
this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 18 April

2018, at Batangas City.

MARY ANN A. MAGADIA

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 18 April 2018, at

Batangas City, affiant, personally known to me.

SONNY JOSE M. RICABLANCA

Notary Public
Until 31 December 2018
PTR No. 3022119 01-03-18 Batangas City
Doc. No. ____; IBP No. 1065629 Batangas City
Page No. ____; Roll No. 69544 Serial No. 2017-20
Book No. ____; MCLE Exempted, pursuant to MCLE Governing
Series of 2018. Board Order No. 1, S.2008
Zenaida Arcade, 43 M.H. del Pilar St., Batangas City

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Affidavit of Loss