REPUBLIC OF THE PHILIPPINES

(Parañaque City, Metro Manila )s.s.

AFFIDAVIT OF LOSS
I, _______________________________________________, single and resident of
_________________________________________________________________________ after
having duly sworn to in accordance with the law, hereby depose and say:

1. That I am a student of PATTS College of Aeronautics located at Lombos Avenue, San

Isidro, Parañaque City;

2. That I possess a _______________________________ issued by the said College;

3. That sometime on ___________________________, I noticed the loss of the said

_________________________;

4. That despite diligent effort on my part to search for ___________________________, I

could not locate the same;

5. That I am executing this affidavit to attest to the truth of all the foregoing and for the
purpose of requesting PATTS College of Aeronautics to issue a new/duplicate
_____________________________ in my name.

_______________________________
AFFIANT

SUBSCRIBED AND SWORN TO BEFORE ME this ___________ day of

___________________ 20_____, at Parañaque City, affiant exhibiting to me his/her ID/COE
No. ________________ issued at PATTS College of Aeronautics on __________________.

Doc No.
Page No
Book No.
Series of 20______.

/eij
OSA A/L Form No. 16-010