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REPUBLIC OF THE PHILIPPINES

) SS

CITY OF

)
AFFIDAVIT OF LOSS OF IDENTIFICATION CARD

I, Catarina Domnique Dacio Fernando, Filipino, of legal age, single and a resident of Blk 9 Lot
41-E Unit D 10th St. Golden Gate Subdivision Talon III, Las Pinas City after having been duly sworn in
accordance with law, hereby depose and say:
1. That I am a holder of a student identification card with student number 2011300350 issued by
San Beda College Alabang.
2. That I used to put said identification card in my school bag, among others;
3. That one day I arrived home from school, I discovered that my school ID Card was no longer
in my bag and a diligent search of said document proved futile and unavailing;
4. That said school identification card was not confiscated by the authorities of San Beda
College Alabang by reason of any violation of school rules and regulations;
5. That I am executing this affidavit to attest to the truth of the foregoing facts and to request for
a replacement of said school ID card from San Beda College Alabang
IN WITNESS WHEREOF, I have hereunto affixed my signature this 13 th day of November
2015 at Las Pinas Philippines

Catarina Domnique D. Fernando

SUBSCRIBED TO AND SWORN TO before me, a notary public in and for ____________ this ___ day
of November 2015, the affiant whom I identified through her Passport with Passport No. EC4706316
issued by DFA MANILA, valid from July 21, 2015 to July 20, 2020, personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of the contents of said
instrument.

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