Republic of the Philippines)

Province of Leyte ) SS
Municipality of Alangalang)

AFFIDAVIT OF LOSS

I, _____________________, of legal age, Filipino, single and a

resident of _____________________, after having been sworn to
according to law, hereby depose and state:

1. That I am a 2nd Year BEED Student of _________________;

2. That I was issued by said school a Student Identification Card;

3. That on December 09, 2017 at around 12:00 P.M. I noticed

that I my Student ID was no longer in my bag where I usually
place it when I am not in school;

4. That despite diligent search and efforts to locate the said ID, I
could not find it such that I now believe that it is lost beyond
recovery;

5. That I am executing this affidavit to attest to the truth of the

foregoing and to support my application for the reissuance of
a new Student I.D and for whatever legal purpose this may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

___________________ at ______________, Philippines.

JEFFREY C. GRESOLA
Affiant

SUBSCRIBED AND SWORN to before me this 8th day of

January 2018 at ___________________, Philippines.

Doc. No. ____

Page No. ____
Book No. ____
SERIES OF 2018