REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU ) S.S.

AFFIDAVIT OF LOSS

I, GNANADURAI DAVID, LORDSON SAMRAJ, of legal age, Indian

national, single and a resident of 88 Dormitory, Gullas College of Medicine,
Campus, Banilad, Cebu City, under oath hereby depose and say that:

1. I am a student of the University of the Visayas-Gullas College of Medicine

in Banilad, Cebu City ;
2. As part of the requirements of being a student, I was issued a LMS School
ID with no. 2200670;
3. On the November 05, 2023, while I was walking in the school campus, I
brought my school ID with me and put it inside my pocket, however, after
walking for some time I realized that it is no longer with me;
4. My pocket was empty and the school ID must have been dropped along
the school grounds unnoticeably;
5. I tried to locate it in all other places known to me hoping that it was just
misplaced, however I could no longer locate its whereabouts despite
diligent search, and consider it therefore beyond recovery;
6. I have executed this affidavit to certify the foregoing and for whatever
legal purpose this Affidavit may serve best.

IN WITNESS WHEREOF, I have hereunto signed this affidavit on

November 11, 2023 at Cebu City, Philippines.

GNANADURAI DAVID, LORDSON SAMRAJ

Affiant

SUBSCRIBED AND SWORN to before me, this 11th day of November

2023 at Cebu City, Philippines. Affiant exhibited to me his Passport with no.
U3602563, valid until November 08, 2030.

Doc. No.: _______

Page No.: _______
Book No.: _______
Series of 2023.