Republic of the Philippines)

Province of Negros Oriental) S.S.

Municipality of Sibulan . . .)

AFFIDAVIT OF LOSS

I, RYEL LIXEL G. DIVINAGRACIA, of legal age, single, Filipino and a

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

I was previously issued a Silliman University ID with ID No. 20-1-02274;

Sometime on July 16, 2022, while I was traveling from Sibulan, Negros Oriental
to Cebu City, 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 Silliman

University ID with ID No. 20-1-02274 and to attest to the truthfulness and veracity of the
foregoing facts.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________________ in Sibulan, Negros Oriental, Philippines.

RYEL LIXEL G. DIVINAGRACIA

Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public, on this

___________________ , for the Municipality of Sibulan and the Province of Negros
Oriental, Philippines, the above-named affiant, who presented to me his National ID No.
6590-5478-0675-1824, 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