Republic of the Philippines

Provine of Negros Occidental

City of Bago, 6101

AFFIDAVIT OF LOSS

I, Krischan S. Gelasan, Filipino, of legal age, (single / married), and a resident of

Prk.Paghidaet, Brgy.Taloc, Bago City, after being duly sworn in accordance with law, depose
and state:

That as a bona-fide student of University of Negros Occidental Recoletos, I was issued a

Student Identification Card (ID) No. S75718676C;

That to my surprise, I discovered last July 22, 2021 that the said Identification Card could not be
found;

As all efforts to find the same proved unrewarding, it is now safe to conclude that recovery of the
same is an impossibility;

Thus, I execute this affidavit to establish its loss and to support my application for the issuance
of a new Identification Card.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_______________ Philippines.

_Krischan S. Gelasan_
Affiant

SUBSCRIBED AND SWORN TO before me, a notary public in and for

_____________________ this ____ day of ____________ 20___. The affiant, whom I identified
through the following competent evidence of identity:_____________, valid from______
to______ issued by_______________, personally signed the foregoing instrument before me and
avowed under penalty of law to the whole truth of the contents of said instrument.

Notary Public

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