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

I, ______________________, Filipino, of legal age, and a resident of ______________________________________, 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____________________ issued by________________________; 2. That I used to put said identification card in my pouch. 3. That sometime on____________________, 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. Despite diligent search and efforts to locate said document, I could not find it. 5. That said school/company ID card was not confiscated by the authorities of company by reason of any violation of 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 company ID card from ___________________________________________. 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:_____________, valid from______ to______ issued by_______________, 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

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