Republic of the Philippines)

City of Cagayan de Oro ) S.S.

AFFIDAVIT OF LOSS

I, _________________________________, Filipino citizen, __ years old, _ single _ married

_ widow and a resident of ______________________________________ after having been
sworn to an oath in accordance with law, do hereby depose and say:

1. That I the lawful owner/holder of a School ID card duly issued by the University
of Science and Technology of Southern Philippines;

2. That the above-mentioned School ID card was in my possession until I discovered

that the same is missing;

3. That diligent and earnest efforts to locate the same proved futile as said School
ID card is now lost and beyond recovery;

4. That I am executing this affidavit to attest to the truth of t he foregoing for

whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __day of ______, 2018 in
Cagayan de Oro City, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me, this __day of ______, 2018 at Cagayan de Oro
City, Philippines.

Attorney