REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) s.s.

Affidavit of Loss

I, Irene San Carlos of legal age , single and a resident of Blk __ Lot,
Philips North Point Park., P. dela Cruz, San Bartolome, Novaliches , Quezon City
after having been sworn under oath do hereby state the following:

1. That I am the mother of Ivy Loraine S.C. Diola who is studying

at______ and is a grade ___ student under the advisory class of
_______.

2. That sometime last week, my daughter lot her ID card.

3. That she searched everywhere and to no avail. Her ID is nowhere to

be found.

4. That she is attesting to the foregoing and further request the

authorities to issue her a new ID card in replacement of the one that
she lost.

Affiant further sayeth naught.

Irene B. San Carlos

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, This ____ day of September,

2018 affiant exhibiting to me his Identity card No_____________, sufficient
evidence of identity. Further certify that the foregoing is the same is her
voluntary act and deed.

NOTARY PUBLIC

DOC. NO.______
PAGE NO._____
BOOK NO. ____
SERIES OF 2018