Republic of the Philippines)

City of Butuan ..) S.S.

AFFIDAVIT OF LOSS
OF SCHOOL IDENTIFICATION CARD

I, EVA O. HERAMIZ, of legal age, single, Filipino, with residence

address at Paradise, Libertad, Butuan City, under oath, depose and
state that:

1. I am a student taking up BSBA-Finance at ACLC College of

Butuan and as such I was issued a School Identification Card No.
12002493700.

2. However, sometime last December 2014 when I inspected

my bag containing the pertinent documents and papers, I could no
longer locate the said school identification card and despite diligent
search it proved futile and unavailing.

3. I am executing this affidavit to attest the foregoing

statements.

Affiant further sayeth naught.

IN WITNESS WHEREOF I hereunto set my hand this 18 th day of

March 2015 at Butuan City.

EVA O. HERAMIZ
Affiant
PHIC: 18-050096942-1

SUBSCRIBED AND SWORN to before me this 18 th day of March

2015 in Butuan City, Philippines.

Doc. No. ____;

Page No. ___;
Book No. XXIII;
Series of 2015.