REPUBLIC OF THE PHILIPPINES)

QUEZON CITY, METRO MANILA) S.S.

AFFIDAVIT OF LOSS

I, APRYL P. ALICO , of legal age, single, Filipino and resident of No. 19 Aguilar St. Bgy.
Bungad, Quezon City after having been duly sworn to in accordance with law depose and say :

1. That I am a 5th Year student of the Pamantasan ng Lungsod ng Maynila taking up B.S.
Accountancy and as such I am a holder of a Student Library Card;

2. That however, said Library Card was lost unnoticeably while on board a passenger jeep I took
from Luneta going to Quezon City;

3. ;That due to the said incident I was constrained to consider the said Library Card as
irretrievably lost;

4. That I am executing this affidavit to attest to the veracity of the foregoing loss in order to report
the same to the school authorities ;

AFFIANT FURTHER SAYETH NONE.

APRYL P. ALICO
Affiant

SUBSCRIBED AND SWORN to this ___ day of February 2019 in Quezon City, Metro
Manila affiant with Student Identification Card Number 2014-02512 issued by the Pamantasan
ng Lungsod ng Maynila.

Doc. No. _____

Page No. _____
Book No. _____
Series of 2019.