REPUBLIC OF THE PHILIPPINES)

CITY OF MANDAUE
) S.S.

AFFIDAVIT OF LOSS

I, JEYETH C. ALMODIEL, of legal age, Filipino, single, and a resident of

Mantuyong, Mandaue City after having been duly sworn to in accordance with law,
hereby depose and state that:

1. I am a student of Mandaue City College taking up the course of Bachelor of

Science in Business Administration major in Entrepreneurial Management;
2. I was issued an I.D. of the above-mentioned school and the number of which
I do not remember;
3. Sometime on or before March 19, 2016, a fire broke near my residence at
Mantuyong, Mandaue City which subsequently affected my house;
4. The said I.D. issued by the above-mentioned school was lost and burned by
the fire;
5. Earnest efforts were made to locate the aforementioned I.D. but to no avail,
thus, the same is considered lost for all intents;
6. I am executing this affidavit to attest to the veracity of the foregoing
statements, and for enrollment process in the above-mentioned school and
for the re-issuance of the said I.D. and for whatever legal purposes it may
serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 6 th day of

June 2016 at Mandaue City, Philippines.

JEYETH C. ALMODIEL
Community Tax Certificate No. 12650350
Affiant

SUBSCRIBED AND SWORN TO before me this 6 th day of June 2016 at Mandaue

City, Philippines, affiant being personally known to me and exhibiting her Community
Tax Certificate with No. 12650350 as competent evidence of identity.
Doc No. ________

Page No. _______

Book No._______
Series of 2016.