REPUBLIC OF THE PHILIPPINES )

CITY OF ILOILO )S.S.

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AFFIDAVIT OF LOSS

I, DANNIE ANNE CARREON, of legal age, single, Filipino

citizen, and a resident of Pototan, Iloilo, Philippines, after having been
duly sworn to an oath in accordance with law do hereby depose and
state that:

1. I hereby certify that I am a holder of an WVSU ID with

no.___________________ issued by West Visayas State University,
La Paz, Iloilo City;

2. Sometime in March18, 2019 due to inadvertence, WVSU ID

was lost in my possession and despite diligent efforts to search for it,
the same remained lost and is beyond recovery;

3. I execute this affidavit to attest to the truth of the foregoing

with the purpose of submitting this affidavit to the proper authorities
and in support of my application for a new WVSU ID in lieu of the one
lost.

IN TRUTH WHEREOF, I have hereunto set my hand this 19th

day of March 2019 at Iloilo City, Philippines.

DANNIE ANNE CARREON

Affiant/Signature
Drivers’License No.
Issued at Iloilo, Philippines
On:

SUBSCRIBED AND SWORN to before me this 19th day of

March 2019 at Iloilo City, Philippines. Affiant exhibited to me her
Drivers’ License with number _________ bearing her photograph and
signature as proof of her identity.

Doc. No:
Page No:
Book No:
Series of 2019