Darlene C.

Manago
Legal Forms 2023-24
February 1, 2024

Republic of the Philippines}

CITY OF ORMOC}S.S.

AFFIDAVIT OF LOSS

I, MARTIN MARTINA, of legal age, a Filipino citizen, married and a resident

of B13, L3, P3 A-7, Brgy. Iwasthere, Ormoc City, Leyte, Philippines, after having
been duly sworn to in accordance with law, hereby depose and say, THAT:

1. I am a holder of a WLC Student Identification Card, bearing Registration

No. 614, which I would always keep in my wallet;

2. Early in November 2023, when I went to the Department of Foreign

Affairs Tacloban to process my application for a Philippine passport upon entering
the said office, I presented and left my WLC Student Identification Card at the guard
station;

3. Sometime in the third week of December 2023 the office of the

Department of Science and Technology called for me to submit the requirements in
connection with my application for a scholarship grant, however, when I looked for
my WLC Student Identification Card, which is one of the said requirements, it was no
longer in my wallet and that’s when I remembered that I might not have claimed it
back from the guard at the Department of Foreign Affairs Tacloban when I went
there early in November 2023;

4. Unfortunately, when I went back to the Department of Foreign Affairs

Tacloban to recover my WLC Student Identification Card, the same could no longer
be located and its whereabouts cannot be ascertained despite exerting utmost
efforts thereof my efforts proved futile and that my said WLC Student Identification
Card can now be considered as forever lost;

5. The said WLC Student Identification Card was never revoked or

confiscated for any violation whatsoever nor was it used unlawfully;

6. I am executing this affidavit to attest to the veracity of the foregoing facts

and circumstances and for whatever lawful purpose this may serve.

Page 1 of 2
Darlene C. Manago
Legal Forms 2023-24
February 1, 2024

IN WITNESS WHEREOF, I have hereunto set my hand this 2nd day of

February 2024 in Ormoc City, Leyte, Philippines.

MARTIN MARTINA
Affiant
Driver’s License No. H06-16-001934
Valid until May 22, 2025

SUBSCRIBED AND SWORN TO before me this 2nd day of February 2024 in

Ormoc City, Leyte, Philippines, with the affiant having exhibited to me his driver’s
license number H06-16-001934, valid until May 22, 2025 as competent proof of his
true identity, pertinent details of which are indicated below his name.

Doc. No. 7; ROBIN SCHERBATSKY

Page No. 2; Notary Public
Book No. I; Ormoc City, Kananga, Matag-ob
Merida and Isabel, Leyte
Series of 2024.
Until December 31, 2025
Commission No. ORM-21-05-015
Brgy. Dinhi, Ormoc City
Attorney’s Roll No. 72123
PTR No. 7053410
Ormoc City, January 3, 2024
IBP O.R. No. 195131, 1/3/2024
MCLE Exemption Bar Matter No. 890
TIN 248-409-901

Page 2 of 2