Republic of the Philippines )

Province of Cagayan ) S.S.

Tuguegarao City )

AFFIDAVIT OF LOSS

I, JUAN DELA CRUZ, of legal age, married, Filipino, and a resident of

Victoria Heights, Zone 7, Makati City and after having sworn to in accordance
with law, hereby depose and state:

1. That I am an Student of Cagayan State University [CSU], Carig,

Tuguegarao City, Cagayan, taking up Information Technology, and I am on
my 3rd year of school year;

2. That the school issued an ID [ Identification Card] for and in my name;

3. That on January 4, 2018 I boarded a tricycle in going to UNITOP MALL,

Centro Balzain, Makati City, when the tricycle alighted I found out that my
wallet was missing, and one of the items included in the said wallet is my
School ID card;

4. That the said wallet was nowhere to be found and that I exerted efforts to
locate it, but proved futile;

5. That I am executing this affidavit in order to attest to the truth and veracity
of the foregoing statements, and for the school re-issue another school ID for
and in my name in lieu of the lost one.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereby affix my hand this 19th day of

January, 2018, at Tuguegarao City, Cagayan.

MIKE ANGELO M. VILLANUEVA

Affiant

SUBSCRIBED AND SWORN to before me this 19th day of January, 2018

at Tuguegarao City, Cagayan,