REPUBLIC OF THE PHILIPPINES)
CITY          OF             ILOILO ) S.S.
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                                     AFFIDAVIT OF LOSS
       I, AIRA ROSE P. DINSON, 21 years old, single, Filipino and a resident of Passi
City, Philippines under oath depose and state That:
         1.   I was a Nursing student of West Visayas State University, La Paz, Iloilo
              City, Iloilo City;
         2.   I was issued by West Visayas State University a School Identification (ID)
              Card which I usually put in my wallet;
         3.   That sometime on June 2019, I take a Nursing Licensure Exam in Iloilo
              Doctors College at West Avenue, Molo, Iloilo City, I discovered that my
              wallet where I put the said Identification card was missing and despite
              diligent efforts that I exerted to locate and recover the same, it was to
              no avail;
         4.   Hence, I now consider the West Visayas State University Student ID
              Card lost and beyond recovery.
       That I am executing this affidavit to attest to the truth of the foregoing
facts and for whatever legal purpose this may serve best.
    IN WITNESSWHEREOF, I have hereunto signed my name this 11th day of
November 2019 in the City of Iloilo, Philippines.
                                         AIRA ROSE PALENCIA DINSON
                                                   Affiant
              SUBSCRIBED AND SWORN TO before me this 11th day of November
2019 at Iloilo City, Philippines. Affiant exhibited to me her PRC ID Card bearing
number 0918724 Non-Professional Driver’s License ID Card as above indicated
as competent proof of his identity.
Doc No. 38;
Page No. 9;
Book No. VII;
Series of 2019.
                                                            KRISTINE A. CUTANDA-LARIOS
                                                      Notary Public for the Province and City of Iloilo
                                                      2nd Floor, Daclis Building, Bonifacio Drive, Iloilo City
                                                                 Notarial Commission Reg. No. 58
                                                          Valid Until December 31, 2020
                                                                      Roll No. 67235
                                                       IBP OR No. 065928 / January 10, 2019 / Pasig City
                                                                     PTR No. 6437759 / January 9, 2019 / Iloilo City
                                                      MCLE Compliance No. VI-0010974 / Valid until April 14, 2022