REPUBLIC OF THE PHILIPPINES)

CITY OF SORSOGON )) SS.

AFFIDAVIT OF LOSS

I, JOHN SMITH, Filipino, of legal age, single, residing at Sorsogon, after

having been sworn to in accordance with law, do hereby depose and state:

1. That I am a freshman student at the ___________________;

2. As such, I am a bearer of a Student Identification Card as a consequence of

my enrollment in the university;

3. That sometime on October 2020, when we had a school activity, I noticed

that my Student ID was already missing;

4. That the continued loss of said Student ID is prejudicial on my interests and

would cause possible problems in the future;

5. That I exerted reasonable and diligent efforts to locate the same but to no
avail and I therefore considered the same as lost and can no longer be
found;

6. That I am executing this Affidavit to attest to the truth of the foregoing

facts and to use the same for the reissuance of a new student identification
card to my favor.

IN WITNESS WHEREOF, I hereunto affix my signature this ___ day of

_________________, at Sorsogon City.

JOHN SMITH
Affiant

SUBSCRIBED AND SWORN to before me this ___ day of

________________ at Sorsogon City.

Doc No. ________;

Page No. _______ ;
Book No. _______;
Series of _______.