(Affidavit of Loss School ID)

Republic of the Philippines)

Province of ____________________)S.S.
City/Municipality of _____________)
x-------------x

AFFIDAVIT OF LOSS
I, JULIE ANN S. EBREO, Filipino, of legal age, (single / married), and a
resident of Dr. Ramon Soler Ext. Brgy Zone II Atimonan,Quezon , after being
duly sworn in accordance with law, depose and state:

That as a bona-fide student of SOUTHERN LUZON STATE UNIVERSITY, I was

issued a Student Identification Card (ID) No. 13L-0603;

That to my surprise, I discovered last DECEMBER that the said Identification

Card could not be found;

As all efforts to find the same proved unrewarding, it is now safe to conclude
that recovery of the same is an impossibility;

Thus, I execute this affidavit to establish its loss and to support my

application for the issuance of a new Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________

at _____________, Philippines.

Affiant

(JURAT)