AFFIDAVIT OF LOSS OF IDENTIFICATION CARD REPUBLIC OF THE PHILIPPINES ) _____________________________ ) SS.

I, (name of affiant), Filipino, of legal age, single/married to (name of spouse), and a resident of (address of affiant), after having been duly sworn in accordance with law, hereby depose and say: 1. That I am a holder of a school/company identification card bearing serial number (ID number) issued by (school/company name); 2. (State the circumstances leading to the loss of the ID, e.g.:) That I used to put said identification card in my pouch, among others; 3. That sometime on (date of loss), when I arrived home from work, I discovered that my school/company ID card was no longer in my pouch where I used to place it; 4. That diligent effort to locate the same had proved futile; (alternative statements: Diligent search of said document proved futile and unavailing; Despite diligent search and efforts to locate said document, I could not find it, etc.) 5. That said school/company ID card was not confiscated by the authorities of (school/company) by reason of any violation of school/company rules and regulations; 6. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for a replacement of said school/company ID card from (school/company name). IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of ____________ 20___ at ____________, Philippines. _________________________________ (Signature of Affiant over Printed Name) SUBSCRIBED AND SWORN TO before me, a notary public in and for _____________________ this ____ day of ____________ 20___. The affiant, whom I identified through the following competent evidence of identity: (ID type and number), valid from (date) to (date) issued by (issuing authority), personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument. Notary Public Doc. No. ..; Page No. .; Book No. .; Series of 2013.