Republic of the Philippines)

City of Manila ) S.S.

AFFIDAVIT OF LOSS

I, Juan Dela Cruz, of legal age and resident of 20 San Miguel St., Quiapo, Manila under
oath declare that:

1. I was issued a College school I.D. by the College of Law, San Beda College, Manila;
2. I used to keep that I.D. in my bag
3. Last February 3, 2016, while I was in Recto, Manila, my bag together with my school I.D.
was stole.
4. I am executing this sworn statement, as required, to enable me to obtain a replacement
for that school I.D.

IN WITNESS WHEREOF, I have hereunto affixed by signature this 7th day of March, 2016 in
the City of Manila.

(Sgd.) Juan Dela Cruz

Affiant

SUBSCRIBED AND SWORN to before me, in the City of Manila, this 5 th day of June
2016, the affiant ] exhibiting his [Valid Identification Document] issued by [Official Agency] at
[Place of Issuance] on [Date of Issuance].

ATTY. JUAN DELA CRUZ

Notary Public for Manila
Unit I, X Building, Recto, Manila
Appointment No, 123, Until December 31, 2017
IBP No. 123456; 01/10/15- Manila
PTR No. 1234567; 01/10/15- Manila
Roll No. 12345; 4/20/06
MCLE No. I- 001234; 9/09/14
MCLE No. II- 005678; 9/09/14
Serial No. of Commission M- 123