REPUBLIC OF THE PHILIPPINES)

CITY OF PARAÑAQUE )S.S.

AFFIDAVIT OF LOSS

I, (NAME), (age), Filipino, single and a resident in (ADDRESS), after having been duly sworn
to in accordance with law, hereby depose and state THAT:

1. I am (YEAR and WHAT UNIV.);

2. I was issued a School ID with No. (___);
3. Last, May 1, 2018, I have found out upon reaching home that the abovementioned
school ID was lost;
4. 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 (DATE) ) at (CITY),

Philippines.

(__NAME__)
Affiant

SUBSCRIBED AND SWORN TO before me this 3rd day of May 2018 at (CITY),
Philippines, affiant being personally known to me and exhibiting his ID, as competent
evidence of identity under the 2004 RULES OF NOTARIAL PRACTICE.

Doc. No. ____________

Page No. ____________
Book No. ____________
Series of 2018