REPUBLIC OF THE PHILIPPINES}

MALOLOS CITY } S.S.

PROVINCE OF BULACAN }

AFFIDAVIT OF LOSS

I, MARCO D.G. CENTENO, of legal age, Single, Filipino citizen and with
postal and residence address at No. 28 Brgy. Palapat, Hagonoy, Bulacan,
after having been sworn to in accordance with law, do hereby depose
and say, that:
1. I am the holder of a School ID for School Year 2 nd Semester 2015-
2016 with Number with No. 2014600159;
2. Unfortunately, sometime in March 9, 2016 at around 10:30
o’clock in the morning, while riding a motorcycle going to home, when I
got home I learned that my School ID was missing;
3. I exerted all efforts to locate the afore-mentioned School ID
but to no avail;
4. The loss of said School ID was not due to any violation of law
but because of the reason stated herein;
5. I am executing this affidavit to attest to the truth of all the
foregoing facts, and to secure a replacement for my School ID and for all
legal intents and purposes that this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

25 day of July 2016, here at Malolos City, Bulacan.
th

MARCO D.G. CENTENO

Affiant

SUBSCRIBED AND SWORN to before me this 25th day of July 2016,

here at Malolos City, Bulacan. As proof of identity, affiant exhibited to me
his Reg Form with No. 2014600159

ATTY. KENNETH N. MERCADO

Public Attorney I
Public Attorney’s Office
Pursuant to RA 9406