REPUBLIC OF THE PHILIPPINES)

CITY OF CEBU ) S.S.

AFFIDAVIT OF LOSS

I, XANDER FORD, of Legal Age, Filipino, Single, with residential address at

999 Bldg. 1, P. del Rosario St., Cebu City, subscribing under oath, hereby
depose and state:
1. I am a holder of a School Identification (ID) Card bearing I.D. No. 1234567
issued by University of San Carlos;
2. That I used to put the School ID Card in the side pocket of my backpack;
3. That sometime on November 6, 2017, around 9:00 PM, I passed by Colon
Street;
4. That when I arrived home, I discovered that the side pocket of my
backpack was open and my School ID Card was already missing and the
said item is irretrievably lost and can no longer be found despite diligent effort
to locate the same;
5. That the said School ID card was not confiscated by the authorities by
reason of any violation of school rules and regulation; and
6. 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 University of
San Carlos.
IN WITNESS WHEREOF, I have hereunto affixed my signature this 10th
day of November 2017 at Cebu City, Philippines.

XANDER FORD
Affiant

SUBSCRIBED AND SWORN TO before me, this 10th day of November,

2017, in the City of Cebu by XANDER FORD, with Voter’s ID no. 07306874,
issued on January 17, 2016 at Cebu City bearing his photograph and
signature, known to me as the same person who personally signed the
foregoing instrument before me and avowed under penalty of law to the
whole truth of the contents of said instrument.
WITNESS MY HAND AND SEAL this 10th day of September 2017 in Cebu
City, Cebu.

1
Doc. No. 1;
Page No. 1;
Book No. 1;
Series of 2017. MARLOU ARIZALA
Notary Public of Cebu City, San Fernando
and Carcar, Philippines
Commission No. 09-56 UNTIL 12/31/18
RM. 501, SM Seaside, Cebu City
Roll of Attorney’s No. 87753
IBP No. 46637, Cebu City, 01/06/17
PTR No. 0097621, Cebu City, 01/06/17
PTR No. 0097621, Cebu City, 01/06/17