Republic of the Philippines)
Province of ____________________)S.S.
City/Municipality of _____________)
x – – – – – – – – – – – – – x
I, _____________, Filipino, of legal age, (single / married), and a resident of _____________, after being duly sworn in accordance with law, depose and state:
That as a bona-fide student of _____________, I was issued a Student Identification Card (ID) No. _____________;
That to my surprise, I discovered last _____________ that the said Identification Card could not be found;
As all efforts to find the same proved unrewarding, it is now safe to conclude that recovery of the same is an impossibility;
Thus, I execute this affidavit to establish its loss and to support my application for the issuance of a new Identification Card.
IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at _____________, Philippines.