REPUBLIC OF THE PHILIPPINES)

MUNICIPALITY OF __Palompon_______) Sc.

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AFFIDAVIT OF LOSS

I, FRANCIS Q. MACAPAZ, Filipino, of legal age, single and a resident of

_Matlang, Isabel, Leyte_, after being duly sworn in accordance with law, depose and
state that:

1. As a bona fide student of _Palompon Institute of Technology, I was issued a

School ID with No. __20-0688-190_;

2. On or about _March 24, 2023__, I discovered that my said School ID was missing
and I exerted all efforts to locate the same but I could no longer find it;

3. Said School ID has not been confiscated by any officer of the law or by any
school officer for violation of any law, ordinance, decree or school rules and
regulations;

4. As all diligent search and efforts to find the same proved futile, it is now safe to
assume that said School ID is now lost beyond recovery;

5. As such, I execute this affidavit to attest to the truth of the foregoing facts, to
support my application for the issuance of a new School ID, and for whatever
legal purpose that this affidavit may serve;

6. FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this _29th day of May
2024_ in the Municipality of _Palompon__, Philippines.

FRANCIS Q. MACAPAZ
AFFIANT

JURAT

SUBSCRIBED and sworn before me, 29th day of May 2024 , in the Municipality of
Palompon by the above-mentioned affiant whe is personally known to herein notary
public

NOTARY PUBLIC

Doc. No. _____;

Page No. _____;
Book No._____;
Series of 20___.