REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

x----------------------------------x

AFFIDAVIT OF LOSS

I, Jomar M. Jordas, of legal age, Filipino, single and a resident of Calamba city, Laguna, after
having been duly sworn to in accordance with law, depose and state THAT:

1. On December 14, 2013, I was issued a school ID by the De La Salle College of Saint Benilde in
Manila;

2. Last January 28, 2014, I lost the said ID. I tried to look for the said ID but the same could not be
found;

3. Despite diligent search and efforts to locate the said Identification Card, I could not find the same such
that I believe that it is now lost beyond recovery;

4. As such, I am executing this affidavit to attest to the foregoing facts and to support the application for
the issuance of a new one in lieu of the one which was lost.

IN WITNESS WHEREOF, I have hereunto set my hand this February 3, 2014 in Metro
Manila, Philippines.

Jomar Martinez Jordas

Affiant
School ID# 11378093

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his valid proof of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013.