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Republic of the Philippines ) Province of________________ ) S.S.

City/Municipality of_________ ) x- - - - - - - - - - - - - - - - - - - - - -x

AFFIDAVIT OF LOSS OF SCHOOL I.D.


I, ________________, of legal age, (single/widow/married to _____________________), Filipino citizen, and a resident of _______________, Philippines, after being sworn to in accordance with law, depose and state: That as a bona-fide student of _____________, I was issued a Student Identification Card (ID) No. _____________; That to my surprise, I discovered last _____________ that the said Identification Card could not be found; As all efforts to find the same proved unrewarding, it is now safe to conclude that recovery of the same is no longer possible; Thus, I execute this affidavit to establish its loss and to support my application for the issuance of a new Student Identification Card. IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of ___________, 20____ at Barangay ___________, __________, ____________, Philippines.

_____________________ Affiant

(NOTARIAL OATH)

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