REPUBLIC OF THE PHILIPPINES )

CITY OF MUNITNLUPA ) S.S

AFFIDAVIT OF LOSS

I, JOHN YUJI D. KOBAYASHI, of legal age, single, Filipino, and with residence
and postal address at Blk, 1 L24 Carmen Homes, San Pedro, Laguna, Philippines,
after having been duly sworn to in accordance with law, do hereby depose and say:

1. That I am a holder of SCHOOL IDENTIFICATION CARD issued by

LYCEUM OF ALABANG Muntinlupa City;

2. That the said SCHOOL ID CARD was sometimes on December 20 2019

in the vicinity of SM Muntinlupa City;

3. That despite of diligent effort to locate the aforesaid SCHOOL ID CARD,

the same were proved to be futile;

4. That I execute this affidavit in order to attest the truth of the above
facts for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand and affix my signature

th
this 8 day of January, 2020, in the City of Muntinlupa, Philippines.

JOHN YUJI D. KOBAYASHI

Affiant

SUBCRIBED AND SWORN to before me this 8th day of January, 2020, in the
City of Muntinlupa, Philippines, affiant having exhibited to me a current Competent
Identification with ID No. ___________________ issued by the _______________________________.

Doc. No. _________;

Page No. _________;
Book No. ________ ;
Series of 2020