REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AKLAN )
MUNICPALITY OF KALIBO ) S.S.
X - - - - - - - - - - - - - - - - - - - - - - - -X
AFFIDAVIT OF LOSS
I, KIM ZEUS GA-AN, Filipino, of legal age, single and a resident of Pob. Kalibo, Aklan,
Philippines, after having duly sworn to in accordance with law, hereby depose and say
that:
1. I am a holder of a student Identification Card issued by Aklan Catholic College ;
2. I lost said Identification Card on January 19, 2014 and that I exerted all efforts to
locate the same but I could not remember exactly where I placed/left it and it is
considered lost for all legal purposes;
3. Said Identification Card was not confiscated by any officer of the law or the
officers of Aklan Catholic College by reason of any violation of any law,
ordinance, presidential decree or rules and regulation of said university; and
neither was it offered as collateral for any loan;
4. I am executing this affidavit to attest to the foregoing facts;
IN WITNESS WHEREOF, I have hereunto set my hand this 24 th of January 2014
in the Municipality of Kalibo, Philippines.
KIM ZEUS GA-AN
Affiant
SUBSCRIBED AND SWORN to before me this 24th of January 2014 in the
Municipality of Kalibo, Philippines, affiant having exhibited to me his/her community tax
certificate with no. 39274748749 issued on January 10, 2014 at Municipal Hall of Kalibo
.

Doc. No. 31;

Page No. 011;
Book No.009;
Series of 2014.