AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

REPUBLIC OF THE PHILIPPINES) _____________________________ ) SS. I, Joannalyn M. Libo-on, Filipino, of legal age, single and a resident of Aurora Blvd, Quezon City, after having been duly sworn in accordance with law, hereby depose and say: 1. That I am a holder of a school/company identification card bearing serial number 11130040 issued by De La Salle University. 2. That I used to put said identification card in my wallet, among others; 3. That sometime on July 5,2013, when I arrived home from school, I discovered that my school ID card was no longer in my wallet where I used to place it; 4. That diligent effort to locate the same had proved futile; 5. That said school/company ID card was not confiscated by the authorities of De La Salle University by reason of any violation of school/company rules and regulations; 6. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a replacement of said school ID card from De La Salle University.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at ____________, Philippines.

_________________________________ (Signature of Affiant over Printed Name) SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________ 20___. The affiant, whom I identified through the following competent evidence of identity: valid from ___________ issued by ______________, personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument. Notary Public Doc. No. ..; Page No. .; Book No. .; Series of 2013.