AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

REPUBLIC OF THE PHILIPPINES)

_____________________________ ) SS.
I, ______________________, Filipino, of legal age, and a resident of
______________________________________, 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____________________ issued by________________________;
2. That I used to put said identification card in my pouch.
3. That sometime on____________________, when I arrived home from work, I
discovered that my school/company ID card was no longer in my pouch
where I used to place it;
4. Despite diligent search and efforts to locate said document, I could not
find it.
5. That said school/company ID card was not confiscated by the authorities
of company by reason of any violation of 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 company ID card from
___________________________________________.
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______ to______ 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

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Series of 2011.