Republic of the Philippines) Province of Metro Manila, S.S.

) City/Municipality of Valenzuela) x-------------x

AFFIDAVIT OF LOSS
I, BASTIAN MIGUEL Y. LOMONGO Filipino, of legal age, (single / married), and a resident of #129 DECENA ST. ARKONGBATO VALENZUELA CITY, after being duly sworn in accordance with law, depose and state: That as a bona-fide student of SAN BEDA COLLEGE, COLLEGE OF ARTS AND SCIENCES, I was issued a Student Identification Card (ID) No. C-100131. That to my surprise, I discovered last DECEMBER 2013, 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 impossibility; Thus, I execute this affidavit to establish its loss and to support my application for the issuance of a new Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd of January 2014 at Caloocan City.

____________________________________ LOMONGO, BASTIAN MIGUEL Y.

SUBSCRIBED AND SWORN to before me this 3rd of January 2014, affiant exhibited to me his/her Competent Evidence of Identity by way of Supporting Identification Cards issued by the same institution. ATTY. MARIANO DIMACULANGAN NOTARY PUBLIC Doc. No. ______; Page No. ______; Book No. ______; Series of ______.