Republic of the Philippines)

Province of Negros Oriental) S.S.

Municipality of Sibulan . . .)

AFFIDAVIT OF LOSS

I, MARK ANGEL F. DIPUTADO, of legal age, single, Filipino and a resident

of Magatas, Sibulan, Negros Oriental, after having been duly sworn to in accordance with
law, state and declare that:

I was previously issued a Negros Oriental State University School ID with ID No.
201904424;

That the above-mentioned ID while in my possession was lost and could no

longer be located despite of exerting efforts of locating it. Perhaps, it was misplaced
somewhere;

I have exerted diligent search and efforts to locate the above-mentioned ID but the
same has not been found or recovered up to the present such that I now believe that it is
now lost beyond recovery.

I am executing this Affidavit of Loss to establish the fact of loss of my Negros

Oriental State University School ID with ID No. 201904424 and to attest to the
truthfulness and veracity of the foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 23rd day of

August 2022 at Sibulan, Negros Oriental, Philippines.

MARK ANGEL F. DIPUTADO

Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of August 2022, in

Sibulan, Negros Oriental, Philippines, personally appeared the above-named affiant, who
presented to me his National ID No. 2167-4278-5476-0563, WHO SIGNED IN MY
PRESENCE the foregoing document (Affidavit of Loss), and who avows under
PENALTY OF LAW to the whole truth of the contents of the same.

Doc No. ___;

Page No.___;
Book No. ___;
Series of 2022.

Affidavit of Loss