Republic of the Philippines)

Province of Cotabato )s.s

Municipality of Carmen )

AFFIDAVIT OF LOSS

I, FRITZEL DIANE S. MAÑARA, of legal age, single, Filipino and a resident of

Carmen, Cotabato after having been duly sworn in accordance with law do hereby depose
and say:

1. That I am a holder of SCHOOL ID issued by University of the Immaculate

Conception Davao City,

2. That I have discovered that said SCHOOL ID was no longer in the place
where I have kept it;

3. That despite diligent efforts in locating said SCHOOL ID the same could
no longer be located;

4. That said SCHOOL ID was not confiscated nor encumbered by any lawful
authority but was really lost;

5. That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 14st day of June 2019
at Carmen, Cotabato, Philippines.

FRITZEL DIANE S. MAÑARA

Affiant

SUBSCRIBED AND SWORN to before me this 14st day of June 2019 at Carmen,
Cotabato, Philippines.

JOSEPH N. MADRIAGA
Doc. No. _____; Notary Public
Until December 31, 2019
Page No. _____; Roll of Attorneys No. 71479
Book No. _____; PTR No. 9238373/01-18-19
Series of 2019. IBP O.R. No. 098638/01-24-19