REPUBLIC OF THE PHILIPPINES)

CITY OF ANTIPOLO ) S.S.

x----------------------------x

AFFIDAVIT OF LOSS

I, BRIXTON VINCENT G. REYES, of legal age, Filipino,

single, and a resident of Cainta, Rizal, after having been duly
sworn to in accordance with law, depose and state THAT:

1. I am a 1st year college student enrolled at University of Asia

& the Pacific (UA&P) and authorized holder of a UA&P
student identification (Student ID) card that was issued
with ID number 171623 which is valid until April 30, 2020.

2. Sometime on February 10, 2017, said student ID card was

lost when a thief snatched my wallet which contained it from
my pocket while I was walking along Epifanio De Los Santos
Ave. (EDSA) at night. Immediately thereafter, I reported said
incident to a Philippine National Police (PNP) station,

3. Efforts were exerted to locate the person who snatched my

wallet that contained said student ID card, but in spite of
diligent search as well as help from the PNP, it could not be
found and the same is now beyond recovery;

4. Said student ID card has not been revoked by the Registrar

of UA&P for any violation of university rules & regulations;

5. 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 UA&P student ID card, in lieu of the one
that was lost;

IN WITNESS WHEREOF, I have hereunto set my hand

this February 16, 2017 in Antipolo City, Rizal, Philippines.

Brixton Vincent G. Reyes

Affiant
 LTO (Non) Professional
Drivers License No. N04-11-
023518

SUBCRIBED AND SWORN TO before me this February

16, 2017 in Antipolo City, Rizal, Philippines, affiant
exhibiting to me his competent evidence of identity by way
of LTO (Non) Professional Drivers License issued at the City
of Manila on January 5, 2015.

Doc. No. 47000

Page No. 781
Book No. 435
Series of 2017.