REPUBLIC OF THE PHILIPPINES)

CITY OF DAVAO ) S.S.

AFFIDAVIT OF LOSS

I, ADELE LAURIE BLUE ADKINS, of legal age, Filipino, Single, and

a resident of 21 St. London Village, Davao City, after being sworn to an in
accordance with law, do hereby depose and say:

1. That I am a holder of JOSE MARIA COLLEGE (JMC)

IDENTIFICATION CARD (I.D.);

2. That sometime last December 5, 2019, while I was on my way home, I

inadvertently left my bag containing my important documents such as
the above JMC I.D. CARD;

3. That I exerted my best efforts to locate said JMC I.D CARD but to no
avail;

4. That the said JMC I.D. Card is considered lost for all legal purposes;

5. That I am executing this affidavit to apprise JOSE MARIA COLLEGE

of the circumstances surrounding the loss of said JMC I.D. CARD and to
secure a replacement of the same;

IN WITNESS WHEREOF, I have hereunto set my hand this 13th of

December, 2019, in the City of Davao, Philippines.

ADELE LAURIE BLUE ADKINS

Affiant
 SUBSCRIBED AND SWORN to before me this December 13, 2019, in
the City of Davao, Philippines, affiant ADELE LAURIE BLUE ADKINS
having exhibited her CTC No. 12767067 issued on July 15, 2019 at Davao
City.

ATTY. MARY BESSADEL B. DULAY

Notary Public for Davao City
Notarial Commission No. 12-2019
Commission expires on December 31, 2021
Roll of Attorneys No. 45454;
IBP No .09876; issued 01/05/2019; IBP Davao City
PTR No.06789; issued 01/10/2019; Davao City
Berlay Bldg., Awhag Subd. Bacaca Road, Davao City

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