affidavit

1. Republic of the Philippines )
ARAYAT, PAMPANGA ) S.S.
AFFIDAVIT OF LOSS
KNOW ALL MEN BY THESE PRESENTS:
I, _______________________________________, age ___, Filipino, single/married, a
resident of ________________________________________________, and taking up the
degree/vocational course of _________________________________________ at
________________________________ after having been sworn in accordance with law,
hereby deposes and states the following:
1. THAT I am holder/owner/ or possessor of the following SCHOOL
IDENTIFICATION CARD (ID) with student number:
_____________________________;
2. THAT sometime on _____________________________, I discovered that I lost
said SCHOOL IDENTIFICATION CARD due to
__________________________________________________________________
__________________________________________________________________
_________________________________________________________________;
3. THAT I have recently discovered the said SCHOOL IDENTIFICATION CARD
irretrievably lost and can no longer be found despite diligent efforts to locate the
same;
4. THAT I execute this affidavit to attest to the truth of the foregoing statements.
IN WITNESS WHEREOF, I have hereunto affix my signature this _____ day of
________________, 20____, at ____________________________________, Philippines.
______________________________
Affiant
(Signature over Printed Name)
SUBSCRIBED AND SWORN TO before me a notary public this ________ day of
_________________, 20____. The affiant whom I identified through the following
competent evidence of identity ____________________________________________
valid until _____________________ and issued by ______________________________,
personally signed the foregoing statement before me and understood the same foregoing
statements.
WITNESS MY HAND AND SEAL.
Notary Public
Doc. No. _________
Page No. _________
Book No. _________
Series of : ________