Republic of the Philippines)

Calapan City ) S.S.

AFFIDAVIT OF LOSS

I, A, of legal age, Filipino, single and with residence and postal address at Brgy.
Sta. Maria, Naujan, Oriental Mindoro, after having been sworn to in accordance with
law, hereby depose and state that:

1. Last year 2022, I was staying in an apartment located in Naujan, Oriental

Mindoro;

2. That, previously, I have in my possession the Library Card issued by

Mindoro State University;

3. That, I recently discovered that said Library Card was no longer in the
place where I usually place the same;

4. That, I exerted earnest efforts to locate and retrieve the same, but all my
efforts have been proven to be futile despite diligent search made and
undertaken.

5. That, I executed this affidavit to attest to the fact of the foregoing and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 13 February

2023 at Calapan City, Philippines.

A
Affiant
School ID: C1

SUBSCRIBED AND SWORN TO before me this 13 February 2023 at Calapan

City, Philippines. The affiant being personally known to me and to me known to be the
same person who executed the foregoing instrument freely and voluntarily

NOTARY PUBLIC

Doc. No. _64_

Page No. _14__
Book No. _08
Series of 2023