Republic of the Philippines )

Province of Tarlac
) S.S.
Municipality of Capas
)

AFFIDAVIT OF LOSS
I, DOMININIC OSWALD C. HALILI, of legal age, single, Filipino and
with residence and postal address at #4488 Sitio Estrella, San Rafael, Tarlac City,
after being duly sworn to in accordance with law, hereby depose and state :
1.

That I am a bonafide student of Tarlac State University taking up

Bachelor of Laws ;

2.

That being a student, I was issued a corresponding student

identification card by said school authorities and which document I
kept in my wallet for the purpose its use;

3.

That on February 03, 2014, I discovered said ID to be missing

from my wallet where I know I have kept it and that despite diligent
search effort exerted to locate the same, I could no longer find it and it
is now deemed lost;

4.

That I have executed this affidavit to declare the fact of loss of my

student identification card issued by Tarlac State University for the
purpose of inducing the concerned school to issue me the same in lieu
of the loss one ;

5.

That I am executing this affidavit in order to attest to the truth of

all the forgoing facts and for all other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 04 th day of

February 2014 at the Municipality of Capas, Province of Tarlac, Philippines.

____________________________
DOMININIC OSWALD C. HALILI
Affiant
SUBSCRIBED AND SWORN TO before me this 04th day of February 2014 at
the Municipality of Capas, Province of Tarlac, Philippines, affiant having
exhibited to me his Professional Identification Card with Reg. No. 0583616 issued
by Professional Regulation Commission.
Doc. No.______;
Page No.______;
Book No. _____;
Series of 2 0 1 4.