Affidavit of Loss

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 1

REPUBLIC OF THE PHILIPPINES)

CITY OF TACLOBAN) S.S.

AFFIDAVIT OF LOSS

I, Clyde Jeffrey A. Reyno, of legal age, Filipino, single and a resident of residential
address, after having been duly sworn to in accordance with law, depose and state
THAT:

1. I am an enrolled student of Eastern Visayas State University and was issued a


valid student identification card with ID number 2022-02483;

2. That to my surprise, I discovered sometime in June 23, 2023 that the said
identification card could not be found;

3. Efforts were exerted to locate said identification card, but in spite of diligent search, it
could not be found and the same is now beyond recovery;

4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and
to support my application for the issuance of a new identification card, in lieu of the one
that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand , at Tacloban City,


Leyte, Philippines.

____________________
Affiant

SUBCRIBED AND SWORN before me this __________________ in _________________,


Philippines, affiant exhibiting to me his/her competent evidence of identity by way of
__________________ issued at ______________ on __________________.

Doc. No. _____;


Page No. _____;
Book No. _____;
Series of 20__

You might also like