Republic of the Philippines)

Cebu City ) S.S.

AFFIDAVIT OF LOSS
I, JEFFRHYL B. ARGAWANON, Filipino, of legal age, and a resident of
Cebu City, Philippines, after having been sworn to in accordance with law, hereby
depose and say that:

1) I am a holder of a school ID of Bohol Island State University Clarin

Campus and bearer of Land Bank ATM Card;

2) On December 16, 2022, when I rode a taxi heading home, my wallet fell
from my pocket containing said school ID and ATM Card;

3) That despite diligent efforts to locate and retrieve said school ID and
ATM Card, the same proved futile and of no avail;

4) I declared for all intents and purposes that said school ID and ATM Card
are now lost and beyond recovery;

5) I hereby execute this Affidavit to attest to the truth of the foregoing facts
and to support my application for the issuance of a new ID and ATM
Card in lieu of the lost ones.

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

December 2022 in Cebu City, Philippines.

JEFFRHYL B. ARGAWANON
Affiant

SUBSCRIBED AND SWORN TO before me this __________ day of

December 2022, in Cebu City, Philippines, affiant exhibiting to me his CTC
Number _______________, issued on ____________ at Cebu City, Philippines.

Doc. No. ____;

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