REPUBLIC OF THE PHILIPPINES}

CAINTA RIZAL }SS

AFFIDAVIT OF LOSS

I, -__________________, single, of legal age, Filipino, residing at

_____________________________, after being duly sworn to in accordance with law, do
hereby depose and say that:

1. I was a student of __________________________________________ from the year

2013-2014;

2. I was issued a School Id For the School Year 2013-2014;

3. Last June, 2014, I discovered the loss of my said School ID from among my
belongings;

4. Efforts were exerted to recover the said School ID, but in spite of diligent
efforts, the same could not be recovered;

5. In the event that the said School ID should hereafter be found or located, I
undertake to forward or surrender the same to the
___________________________________, for its appropriate disposal;

6. I am executing this Affidavit of Loss to attest to the truth of the foregoing for
whatever legal purpose it may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 18th of May

2018 at Cainta Rizal.

___________________________
Affiant

SUBCRIBED AND SWORN TO before me this 18th day of May 2018 in Cainta,
Rizal, affiant exhibiting to me his competent evidence of identity by way of
_____________________________________.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2018.