REPUBLIC OF THE PHILIPPINES)

ILOILO CITY )SS.

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AFFIDAVIT OF LOSS
(School I.D. – WVSU)

I, MARJOE RENZ DOMINIC P. DEITA, of legal age, Filipino, single

and resident of Brgy. Tuburan, Pototan, Iloilo, under oath depose and state,
that:

1. I am currently a 3rd year B.S. Biology student studying at West

Visayas State University in Iloilo City;

2. I was issued a school identification (I.D.) card when I enrolled in my

first year of college during the 1 st Semester of school year 2014-2015 re-
validated yearly ;

3. Recently, I tried to look for my school I.D. but I have misplaced it

and could no longer find the same;

4. Despite diligent effort on my part to locate my school I.D., the same

could not be found and I now consider it lost beyond recovery for all legal
intents and purposes; and

5. I am executing this affidavit for the purpose of attesting to the loss of

my school I.D. in order to facilitate the replacement thereof and to attest to the
truth of the foregoing facts.

AFFIANT FURTHER SAYETH NAUGTH.

IN WITNESS WHEREOF I have hereunto set my hand this

_____________ in the city of Iloilo, Philippines.

MARJOE RENZ DOMINIC P. DEITA

Affiant

SUBSCRIBED AND SWORN to before me this __________________

in the city of Iloilo, Philippines, affiant is personally known to me hence there
is no need to present any Competent Evidence of Identification.

Doc No.: 132 ;

Page No.: 27 ;
Book No.: XX ;
Series of 2016.