AFFIDAVIT OF LOSS

I, WILHELM N. ANDRIN, of legal age, Filipino, and a resident of Brgy. Cayponce,

Balayan, Batangas after having been duly sworn on oath in accordance with law hereby
voluntarily depose and say:

1. That I was issued a Student Identification Card by the Information and

Technology Services of Batangas State University ARASOF-Nasugbu
Campus on August 2019;

2. That sometime around January 2023 the same was inadvertently misplaced;

3. That despite my diligent effort to locate the same it is nowhere to be found;

4. That I am executing this affidavit to attest to the truth of the foregoing facts
and for whatever legal purpose this will serve;

IN TRUTH WHEREOF, I have hereunto signed my name below, this 10 th day of July
2023 at Lian, Batangas.

WILHELM N. ANDRIN
Affiant

SUBSCRIBED AND SWORN to before me, this 10 th day of July 2023, by

WILHELM N. ANDRIN, who exhibited to me his Philhealth ID with No. 09-250050612-3
issued at Lemery, Batangas

Notary Public

ATTY.
GERARDO R. MANALO
PTR No. 31441816
IBP No. 297229
Roll of Attorney No. 42160
Until December 31, 2023