REPUBLIC OF THE PHILIPPINES

CITY OF BATANGAS) S.S.

AFFIDAVIT OF LOSS

I, ___________________________, of legal age, single, Filipino citizen, and a resident

of ________________________________, after being duly sworn to in accordance with law,
depose and state THAT:

1. I am currently enrolled as 2nd year student at University of Batangas taking up

Bachelor of Science in Management Accounting;
2. As such, I was issued a School Identification Card;
3. Recently, while completing my requirements for scholarship, I discovered that my
school identification card is no longer in my bag where I placed it;
4. Despite of diligent efforts to locate its whereabouts, it is nowhere to be found;
5. Because of this, I declared that the said school id is now lost beyond recovery;
6. I am executing this Affidavit to attest to the truth of the foregoing and to support my
request for re-issuance of a new school identification card in lieu of the one that was
lost.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of

_______________ at Batangas City, Philippines.

ID: _____________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of _____________________

at Batangas City, affiant exhibiting to me her competent proof of identity.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2023