Republic of the Philippines )
Camiling, Tarlac ) S.S.
AFFIDAVIT OF LOSS
I, ________________, __ears old, Filipino citizen, single,
and a resident of _________________, Philippines, after having
been duly sworn to in accordance with law, do hereby depose and
state THAT:
1. As a student of the __________________, I was issued a
Student Identification Card (ID) with number
_____________;
2. On ___________, the said identification card was
misplaced/lost and could not be found/located;
3. All my diligent efforts exerted to find the said ID card
proved futile; hence, I now consider the same as lost and
beyond recovery;
4. My student identification card was never pledged or used to
secure any obligation;
5. I am executing this affidavit to attest to the truthfulness of
the above statements and to support my application for the
issuance of a new Identification Card.
IN WITNESS WHEREOF, I have hereunto set my hand this
___ day of ______, 2018 at ___________.
_________________
Affiant
SUBSCRIBED AND SWORN to before me on the date and
place indicated above. Affiant exhibited to me her ___________.
Doc. No.:________;
Page No.:________;
Book No.:________;
Series of 2018.