Republic of the Philippines)

City of Cagayan de Oro )S.S.

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AFFIDAVIT OF LOSS

I, JENJEN L. MOÑER, 17 years of age, single, Filipino, and a resident of

Libagong, Villaba, Leyte, after having been duly sworn to law, hereby depose and say:

1. That I am a student of Villaba National Comprehensive High School and was

issued an Identification Card, which is my only valid identification;

2. That on March 16, 2019, at around 3:00 o’clock in the afternoon, while I was
in Agora, Cagayan de Oro City, I noticed that my Id was missing from my pocket where
it was kept;

3. That despite diligent and exhaustive efforts to find the said school ID, the
same could not be located and now considered beyond retrieve;

4. That I am executing this affidavit to attest to the veracity of the foregoing

facts, and for whatever legitimate purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 16 th day of March,

2019, at Cagayan de Oro City, Philippines.

JENJEN L. MOÑER
- Affiant-

SUBSCRIBED AND SWORN TO before me this 16 th day of March, 2019 at

Cagayan de Oro City, Philippines, affiant having established to me her identity through
satisfactory evidence.

Doc No.
Page No.
Book No.
Series of 2019