REPUBLIC OF THE PHILIPPINES)

C I T Y OF N A G A )S.S.

AFFIDAVIT OF LOSS

I, SHIELA MARIE Q. JARDINEL, of legal age, Filipino, single, resident of

Gaongan, Sipocot, Camarines Sur under oath, hereby depose and state:

1. That, at present, I am a second year college student of the

University de Sta. Isabel, Naga City, taking up Bachelor of Science and
Business Administration;

2. That, as such student, I was issued by the said School an

Identification (ID) Card with No. 18-00541;

3. That yesterday, January 13, 2020, I still used my school ID

when I went to school;

4. That, however, at around 6:00 in the evening, yesterday, when I

reached the boarding house where I am temporarily staying, I noticed that
my school ID was nowhere to be found;

5. That I have exerted earnest efforts to find my school ID

but to no avail;

6. That I am executing this Affidavit to attest to the truth and

veracity of the foregoing facts and to explain the circumstances
leading to the loss of my school ID;

IN WITNESS WHEREOF, I have hereunto set my hand this 14 th day of

January, 2020 at Naga City, Philippines.

SHIELA MARIE Q. JARDINEL

Affiant

SUBSCRIBED AND SWORN to before me in the City of Naga this 14 th

day of January, 2020 by SHIELA MARIE Q. JARDINEL, with Student NO. 18-
00541, personally known to me, who is the same person who personally signed
before me the foregoing affidavit and acknowledged that she executed the same.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.