REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA) S.S.

AFFIDAVIT OF LOSS
I, name, of legal age, Filipino, single and a resident of residential address, after having
been

duly

sworn

to

in

accordance

with

law,

depose

and

state THAT:

1. I am an enrolled student of school and was issued a valid student identification card
with ID number

2. That to my surprise, I discovered sometime in date that the said identification card
could not be found;
3. Efforts were exerted to locate said identification card, but in spite of diligent search, it
could not be found and the same is now beyond recovery;
4. As such, I am executing this Affidavit of Loss to attest to the truth of the foregoing and
to support my application for the issuance of a new identification card, in lieu of the one
that was lost;
IN WITNESS WHEREOF, I have hereunto set my hand this date at Manila City,
Metro Manila, Philippines.

____________________
Affiant
SUBCRIBED

AND

SWORN

TO before

me

this ___________________ in

_________________, Philippines, affiant exhibiting to me his/her competent evidence of

identity

by

way

of

on __________________.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 20__.

__________________

issued

at

______________