Republic of the Philippines

Province of Camarines Sur

City of Naga

AFFIDAVIT OF LOSS
I, Jehusaphat G. Mortega, Filipino, of legal age, (single), and a resident of Mangga
St., Brgy. Sta. Cruz, Naga City after being duly sworn in accordance with law,
depose and state:

That as a bona-fide student of University of Nueva Caceres, I was issued a Student

Identification Card (ID) No.19-56013;

That to my surprise, I discovered last September 24, 2019 that the said
Identification Card could not be found;

As all Efforts were exerted to locate said identification card, but in spite of diligent
search, it could not befound and the same is now beyond recovery;

Thus, I execute this affidavit to establish its loss and to support my application for
the issuance of a new Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at Naga

City, Camarines Sur, Philippines.

_____________________

Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way
of __________________ issued at ______________ on __________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 20__.