REPUBLIC OF THE PHILIPPINES )

Province of Davao del Norte )S.S

City of Tagum )
x---------------------x

AFFIDAVIT OF LOSS

I, JOSEPH M. TOMBO, JR., Filipino, single, of legal age, and a resident of

Poblacion, New Bataan, Davao de Oro, Philippines, after having been duly sworn to in
accordance with the law, do hereby depose and say THAT;

1. I am the holder/owner/possessor of a School Identification (ID) Card issued under

my name by the University of Southeastern Philippines – Tagum (USeP-Tagum), which I
safely kept in my cabinet;

2. Sometime last month, I discovered that the said School ID was no longer in the
cabinet where I placed the same;

3. Thereafter, continuous and diligent search efforts were undertaken to locate the said
School ID, but the same was fruitless; thus, I now deem that the same is lost for all intents and
purposes;

4. I am executing this Affidavit of Loss to attest to the truth of the foregoing, to apprise
the proper authorities or concerned offices, and for whatever legal purposes that this may serve.

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

_________________________, Philippines.

JOSEPH M. TOMBO, JR.

Affiant

SUBSCRIBED AND SWORN to before me this _________________at

________________________, Philippines.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of ____.