Republic of the Philippines}

City of Mandaue} s.s.

AFFIDAVIT OF LOSS
(Report Card)
I, MARIA MAKILING, of legal age and residing at Casili, Mandaue City, after
having been sworn in accordance with the law, hereby depose and state that:

1. I am a Grade 11 student of University of Cebu – Banilad Campus with

I.D. No. 123456789.

2. On April 10, 2019, I received the original copy of my report card for the
school year 2018-2019.

3. On April 12, 2019, I submitted my scholarship application together with

the documentary requirements including a machine copy of said report
card to the office of Aboitiz Foundation in Banilad, Cebu City. I
presented to the personnel in charge the original copy of said report card
for comparison with the machine copy I submitted.

4. On October 17, 2019, while preparing the enrollment requirements for

the second semester of school year 2019-2020, I discovered that my
report card for school year 2018-2019 is missing.

5. Said report card can no longer be found despite diligent search and
efforts to locate the same.

6. I am executing this Affidavit to attest to the foregoing and to support my

application for the re-issuance of a copy of my report card for SY 2018-
2019.

IN WITNESS WHEREOF, I have hereunto set my hand this

_________________ in Mandaue City, Cebu, Philippines.

MARIA MAKILING
Affidavit

SUBSCRIBED AND SWORN TO BEFORE ME this _______________ in

Mandaue City, Cebu, Philippines affiant exhibited to me her University of Cebu Student
ID Card with No. 123456789 bearing her signature and photograph.

Doc. No. _______

Page No._______
Book No._______
Series of 2019.