Affidavit of Loss School ID

January 9, 2017

Republic of the Philippines)

Province of ____________________)S.S.
City/Municipality of _____________)
x–––––––––––––x

AFFIDAVIT OF LOSS

I, _____________, Filipino, of legal age, (single / married), and a resident of

_____________, after being duly sworn in accordance with law, depose and state:

That as a bona-fide student of _____________, I was issued a Student Identification

Card (ID) No. _____________;

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

As all efforts to find the same proved unrewarding, it is now safe to conclude that
recovery of the same is an impossibility;

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

_____________, Philippines.

Affiant