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REPUBLIC OF THE PHILIPPINES)

TARLAC CITY )S.S.

AFFIDAVIT

I, PATRICK VINCENT A. RUBI, of legal age, and a resident of Zone 3B,


Maliwalo, Tarlac City, after having been duly sworn to in accordance with law, do
hereby depose and say, to wit:

1. That I am a holder of school ID with Student ID No. 2014300226


issued by Tarlac State University;

2. That sometime on September 20, 2018, the above-said ID was


lost/missing;

3. That recently, despite diligent efforts exerted to locate the same, it


could no longer be found and is now deemed lost and beyond
recovery;

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


foregoing statements and facts.

AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this 25th day of


September 2018 at Tarlac City, Philippines.

PATRICK VINCENT A. RUBI


Affiant

SUBSCRIBED AND SWORN to before me this 25th day of September 2018


at Tarlac City, Philippines.

Doc. No. _____;


Page No._____;
Book No._____;
Series of 2018.