REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU ) S.S.

AFFIDAVIT OF LOSS

 I, JANNAH HARRA G. MASUHAY, of legal age, Filipino, single and

a resident of Talamban, Cebu City, after having been duly sworn to in
accordance with law, depose and state THAT:

1. I am an enrolled student of University of San Carlos – Talamban Campus

and was issued a valid student identification card with ID number
21100954;

2. Last November 27, 2022, I have found out upon reaching home that the
abovementioned school ID was lost;

3. It is my belief that the said ID was lost while I was riding a jeep on my
way home from mall;

4. Efforts were exerted to locate said identification card, but in spite of

diligent search, it could not be found and the same is now beyond
recovery;

5. As such, I am executing this Affidavit of Loss to attest to the truth of the

foregoing and to support my application for the issuance of a new
identification card, in lieu of the one that was lost;

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

City, Philippines.

___________________________
JANNAH HARRA G. MASUHAY
Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of __________________ issued at ______________
on __________________.

Doc. No. _____;

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