Republic of the Philippines )

City of Iloilo

) s.s

AFFIDAVIT OF LOSS OF SCHOOL IDENTIFICATION CARD

I, Ruzzel Diane Oducado, Filipino, of legal age, single and a resident of
123 Jalandoni St., Jaro, Iloilo City, after having been duly sworn in accordance
with law, hereby depose and say:
1. That I am a holder of a school identification card bearing ID number
05-1357-95 issued by Central Philippine University;
2. That I used to put said identification card in my wallet;
3. That sometime on February 29, 2016, when I arrived home from
school, I discovered that my school ID card was no longer in my wallet where
I used to place it;
4. That I might have inadvertently dropped the said school ID card
when I dished out money from my wallet for jeepney fare;
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.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
8th day of March 2016 in Iloilo City, Philippines.
RUZZEL DIANE I.
ODUCADO
Affiant
SUBSCRIBED AND SWORN TO before me this 8th day of March 2016
in Iloilo City. The affiant, whom I identified through the following competent
evidence of identity: Postal ID, valid from January 2015 to January 2017
issued by Philippine Post Office, personally signed the foregoing instrument
before me and avowed under penalty of law to the whole truth of the
contents of said instrument.
ATTY. MAYREN P. ABUCION
Notary Public
Until December 31, 2015
PTR No. 1234567
IBP No. 58637
Roll No. 123456
MCLE Compliance No. 000123

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Page No. ___;
Book No. ___;
Series of 2016.